{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:37:23Z","timestamp":1792089443739,"version":"4.4.0"},"reference-count":103,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically compare and rank the relative efficacy of different types of deep brain stimulation (DBS) for gait disorders in patients with Parkinson\u2019s disease (PD), with particular emphasis on three outcomes: motor function (MDS-UPDRS III), Freezing of Gait Questionnaire (FOG-Q), and normal gait velocity (cm\/s). The goal is to provide evidence-based guidance for individualized neuromodulation strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Following a preregistered protocol (PROSPERO CRD420251074368), a comprehensive literature search was conducted from January 1, 2000, to June 15, 2025, across PubMed, Embase, Cochrane Library, and CNKI. Randomized controlled trials (RCTs) meeting predefined PICOS criteria were included, and continuous outcome data for MDS-UPDRS III, FOG-Q and normal gait velocity in the Off-Dopa state were extracted. A frequentist network meta-analysis framework (R, netmeta package) was employed, with mean difference (MD) and 95% confidence intervals (CI) as effect estimates. Heterogeneity was quantified using\n                      <jats:italic>\u03c4<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      and\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistics. Global and local inconsistency tests were applied, and treatment ranking was performed using P-scores. Robustness was examined through fixed- vs. random-effects comparisons, leave-one-out sensitivity analyses, and, where feasible, meta-regression and subgroup analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-five RCTs were included, involving 324 patients in intervention groups and 324 in control groups. (1) MDS-UPDRS III: Network meta-analysis showed that Low-PPNa-DBS produced the greatest improvement in motor function (MD\u202f=\u202f\u221231.20, 95% CI \u201353.25 to \u22129.15,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.0055), followed by PPN-DBS (MD\u202f=\u202f\u221226.00, 95% CI \u201338.92 to \u221213.08,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f\u2264\u202f0.0001) and CuN-DBS (MD\u202f=\u202f\u221223.00, 95% CI \u201342.65 to \u22123.35,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.0218). Additional significant but moderate effects were observed for Posterior-STN-dDBS (MD\u202f=\u202f\u221216.55, 95% CI \u201328.43 to \u22124.68,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.0063), IL-IL-DBS, 60\u202fHz-STN-DBS, 80\u202fHz-STN-DBS, STN-DBS, STN\u202f+\u202fSNr HF-DBS, and STN\u202f+\u202fSNr LF-DBS. Overall heterogeneity was moderate to high (\n                      <jats:italic>\u03c4<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f12.1151,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f68.7%), and heterogeneity testing indicated significant heterogeneity (\n                      <jats:italic>Q<\/jats:italic>\n                      total\u202f=\u202f14.48, df\u202f=\u202f5,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.0128). (2) FOG-Q: None of the DBS modalities yielded statistically significant improvements in FOG-Q scores (all 95% CIs crossed zero,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;gt;\u202f0.05). This outcome exhibited high heterogeneity (\n                      <jats:italic>\u03c4<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f1.3074,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f88.3%) and significant inconsistency (\n                      <jats:italic>Q<\/jats:italic>\n                      total\u202f=\u202f25.61,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.0001), suggesting that current evidence is insufficient to confirm a definitive DBS benefit for freezing of gait. (3) Gait velocity (cm\/s): Network analysis demonstrated that spDBS [MD\u202f=\u202f18.06, 95% CI (10.42, 25.70),\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.0001] and STN-DBS [MD\u202f=\u202f17.58, 95% CI (13.20, 21.95),\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.0001] provided the most pronounced improvements. Conventional aDBS [MD\u202f=\u202f14.80, 95% CI (7.71, 21.89)] and GPi-DBS [MD\u202f=\u202f13.91, 95% CI (2.40, 25.42)] were associated with moderate benefits. Heterogeneity for this outcome was moderate to high (\n                      <jats:italic>\u03c4<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f12.1151,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f65.5%), indicating persistent between-study variability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This network meta-analysis systematically compared the effects of different DBS modalities on gait disorders in PD. For MDS-UPDRS Part III, Low-PPNa-DBS, PPN-DBS, and CuN-DBS yielded the most pronounced and statistically robust improvements. In contrast, analysis of FOG-Q scores revealed no statistically significant effects for any DBS intervention. Regarding gait speed, spDBS and STN-DBS showed clear and significant enhancements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:uri>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251074368<\/jats:uri>\n                      , Identifier: CRD420251074368.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnagi.2025.1723706","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T06:53:42Z","timestamp":1769064822000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Effects of different types of deep brain stimulation on gait disorders in patients with Parkinson\u2019s disease: a network meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"17","author":[{"given":"Yunpeng","family":"Guo","sequence":"first","affiliation":[{"name":"School of Physical Education, Henan Normal University","place":["Xinxiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhanyi","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Physical Education, Henan Normal University","place":["Xinxiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixian","family":"Hou","sequence":"additional","affiliation":[{"name":"Center for General Education Teaching and Research, Northern Henan Medical University","place":["Xinxiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1002\/jrsm.1700","article-title":"Twenty years of network meta-analysis: continuing controversies and recent developments","volume":"15","author":"Ades","year":"2024","journal-title":"Res. Synth. Methods"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.1016\/j.brs.2020.03.017","article-title":"Neural selectivity, efficiency, and dose equivalence in deep brain stimulation through pulse width tuning and segmented electrodes","volume":"13","author":"Anderson","year":"2020","journal-title":"Brain Stimul."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1001\/archneur.62.4.554","article-title":"Pallidal vs. subthalamic nucleus deep brain stimulation in Parkinson disease","volume":"62","author":"Anderson","year":"2005","journal-title":"Arch. Neurol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"056004","DOI":"10.1088\/1741-2552\/abeeaa","article-title":"Computational investigation of the impact of deep brain stimulation contact size and shape on neural selectivity","volume":"18","author":"Anderson","year":"2021","journal-title":"J. Neural Eng."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1007\/s13311-020-00889-4","article-title":"Medical management and prevention of motor complications in Parkinson\u2019s disease","volume":"17","author":"Aradi","year":"2020","journal-title":"Neurotherapeutics"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1602","DOI":"10.1177\/1877718X241292315","article-title":"Subthalamic and nigral stimulation for freezing of gait in Parkinson\u2019s disease: randomized pilot trial","volume":"14","author":"Artusi","year":"2024","journal-title":"J. Parkinsons Dis."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1053\/j.sempedsurg.2018.10.009","article-title":"Systematic reviews and meta-analytic techniques","volume":"27","author":"Baird","year":"2018","journal-title":"Semin. Pediatr. Surg."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"S123","DOI":"10.1016\/j.parkreldis.2015.09.028","article-title":"Adaptive deep brain stimulation in Parkinson\u2019s disease","volume":"22","author":"Beudel","year":"2016","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2284","DOI":"10.1016\/S0140-6736(21)00218-X","article-title":"Parkinson\u2019s disease","volume":"397","author":"Bloem","year":"2021","journal-title":"Lancet"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1002\/mds.26837","article-title":"Sixty-hertz stimulation improves bradykinesia and amplifies subthalamic low-frequency oscillations","volume":"32","author":"Blumenfeld","year":"2017","journal-title":"Mov. Disord."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"639","DOI":"10.3233\/JPD-212793","article-title":"Pedunculopontine and cuneiform nuclei deep brain stimulation for severe gait and balance disorders in Parkinson\u2019s disease: interim results from a randomized double-blind clinical trial","volume":"12","author":"Bourilhon","year":"2022","journal-title":"J. Parkinsons Dis."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1002\/mds.27265","article-title":"Short pulse width in subthalamic stimulation in Parkinson\u2019s disease: a randomized, double-blind study","volume":"33","author":"Bouthour","year":"2018","journal-title":"Mov. Disord."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"563","DOI":"10.3233\/JPD-225031","article-title":"Structural-functional correlates of response to pedunculopontine stimulation in a randomized clinical trial for axial symptoms of Parkinson\u2019s disease","volume":"13","author":"Breit","year":"2023","journal-title":"J. Parkinsons Dis."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1177\/1877718X251348669","article-title":"Unveiling the neural network of freezing of gait in Parkinson\u2019s disease: a coordinate-based network study","volume":"15","author":"Camastra","year":"2025","journal-title":"J. Parkinsons Dis."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"109027","DOI":"10.1016\/j.neuropharm.2022.109027","article-title":"Non-dopaminergic approaches to the treatment of motor complications in Parkinson\u2019s disease","volume":"210","author":"Cenci","year":"2022","journal-title":"Neuropharmacology"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1002\/ana.27099","article-title":"Directional subthalamic deep brain stimulation better improves gait and balance disorders in Parkinson\u2019s disease patients: a randomized controlled study","volume":"97","author":"Cherif","year":"2024","journal-title":"Ann. Neurol."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1186\/s12984-021-00921-4","article-title":"Low-frequency STN-DBS provides acute gait improvements in Parkinson\u2019s disease: a double-blinded randomised cross-over feasibility trial","volume":"18","author":"Conway","year":"2021","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1038\/s41531-021-00276-6","article-title":"Gaps and roadmap of novel neuromodulation targets for treatment of gait in Parkinson\u2019s disease","volume":"8","author":"Cury","year":"2022","journal-title":"npj Parkinsons Dis."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1007\/978-1-0716-1566-9_14","article-title":"Software to conduct a meta-analysis and network meta-analysis","volume":"2345","author":"Daly","year":"2022","journal-title":"Methods Mol. Biol."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1002\/mds.27863","article-title":"Short versus conventional pulse-width deep brain stimulation in Parkinson\u2019s disease: a randomized crossover comparison","volume":"35","author":"Dayal","year":"2020","journal-title":"Mov. Disord."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1002\/mds.29700","article-title":"Management of impulse control and related disorders in Parkinson\u2019s disease: an expert consensus","volume":"39","author":"Debove","year":"2024","journal-title":"Mov. Disord."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1360","DOI":"10.1002\/mds.29066","article-title":"European Academy of Neurology\/Movement Disorder Society-European section guideline on the treatment of Parkinson\u2019s disease: I. Invasive therapies","volume":"37","author":"Deuschl","year":"2022","journal-title":"Mov. Disord."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1177\/1877718X251320941","article-title":"Effects of theta burst stimulation on the parkinsonian gait disorder and cortical gait-network activity","volume":"15","author":"Dutke","year":"2025","journal-title":"J. Parkinsons Dis."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.1093\/brain\/awy019","article-title":"The functional network signature of heterogeneity in freezing of gait","volume":"141","author":"Ehgoetz Martens","year":"2018","journal-title":"Brain"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.1002\/mds.27790","article-title":"Measuring Parkinson\u2019s disease over time: the real-world within-subject reliability of the MDS-UPDRS","volume":"34","author":"Evers","year":"2019","journal-title":"Mov. Disord."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1007\/s40263-021-00888-9","article-title":"COMT inhibitors in the management of Parkinson\u2019s disease","volume":"36","author":"Fabbri","year":"2022","journal-title":"CNS Drugs"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1177\/1877718X241308487","article-title":"A possible pathway to freezing of gait in Parkinson\u2019s disease","volume":"15","author":"Factor","year":"2025","journal-title":"J. Parkinsons Dis."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"757579","DOI":"10.3389\/fnhum.2021.757579","article-title":"Deep brain stimulation treating dystonia: a systematic review of targets, body distributions and etiology classifications","volume":"15","author":"Fan","year":"2021","journal-title":"Front. Hum. Neurosci."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1002\/mds.23583","article-title":"Modulation of gait coordination by subthalamic stimulation improves freezing of gait","volume":"26","author":"Fasano","year":"2011","journal-title":"Mov. Disord."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1186\/s13643-019-1063-z","article-title":"Effects of walking speed on gait biomechanics in healthy participants: a systematic review and meta-analysis","volume":"8","author":"Fukuchi","year":"2019","journal-title":"Syst. Rev."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s40035-020-00191-5","article-title":"Freezing of gait in Parkinson\u2019s disease: pathophysiology, risk factors and treatments","volume":"9","author":"Gao","year":"2020","journal-title":"Transl. Neurodegener."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1038\/s41531-024-00812-0","article-title":"Randomized crossover trial on motor and non-motor outcome of directional deep brain stimulation in Parkinson\u2019s disease","volume":"10","author":"Gharabaghi","year":"2024","journal-title":"npj Parkinsons Dis."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/s1353-8020(99)00062-0","article-title":"Construction of freezing of gait questionnaire for patients with parkinsonism","volume":"6","author":"Giladi","year":"2000","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2129","DOI":"10.1002\/mds.22340","article-title":"Movement Disorder Society-sponsored revision of the Unified Parkinson\u2019s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results","volume":"23","author":"Goetz","year":"2008","journal-title":"Mov. Disord."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"916971","DOI":"10.3389\/fnagi.2022.916971","article-title":"Detection and assessment of Parkinson\u2019s disease based on gait analysis: a survey","volume":"14","author":"Guo","year":"2022","journal-title":"Front. Aging Neurosci."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1111\/joim.13541","article-title":"Deep brain stimulation for Parkinson\u2019s disease","volume":"292","author":"Hariz","year":"2022","journal-title":"J. Intern. Med."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/j.jval.2011.01.011","article-title":"Conducting indirect-treatment-comparison and network-meta-analysis studies: report of the ISPOR Task Force on indirect treatment comparisons good research practices: part 2","volume":"14","author":"Hoaglin","year":"2011","journal-title":"Value Health"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"751242","DOI":"10.3389\/fnhum.2021.751242","article-title":"Comparison of shod and unshod gait in patients with Parkinson\u2019s disease with subthalamic and nigral stimulation","volume":"15","author":"Horn","year":"2021","journal-title":"Front. Hum. Neurosci."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1002\/ana.24974","article-title":"Connectivity predicts deep brain stimulation outcome in Parkinson disease","volume":"82","author":"Horn","year":"2017","journal-title":"Ann. Neurol."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/1471-2288-5-13","article-title":"Estimating the mean and variance from the median, range, and the size of a sample","volume":"5","author":"Hozo","year":"2005","journal-title":"BMC Med. Res. Methodol."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1375","DOI":"10.1002\/mds.20968","article-title":"Association between amantadine and the onset of dementia in Parkinson\u2019s disease","volume":"21","author":"Inzelberg","year":"2006","journal-title":"Mov. Disord."},{"key":"ref42","doi-asserted-by":"crossref","DOI":"10.1101\/2025.02.20.25322374","article-title":"Chronic adaptive versus conventional deep brain stimulation in Parkinson\u2019s disease: a blinded randomized pilot trial","author":"Isaias","year":"2025"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1136\/jnnp.2007.131045","article-title":"Parkinson\u2019s disease: clinical features and diagnosis","volume":"79","author":"Jankovic","year":"2008","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"2890","DOI":"10.1007\/s00415-023-11610-8","article-title":"Effects of motor-cognitive training on dual-task performance in people with Parkinson\u2019s disease: a systematic review and meta-analysis","volume":"270","author":"Johansson","year":"2023","journal-title":"J. Neurol."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1002\/mds.28048","article-title":"A novel DBS paradigm for axial features in Parkinson\u2019s disease: a randomized crossover study","volume":"35","author":"Karl","year":"2020","journal-title":"Mov. Disord."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1038\/s41746-025-01938-y","article-title":"A systematic review of real-world gait-related digital mobility outcomes in Parkinson\u2019s disease","volume":"8","author":"Kirk","year":"2025","journal-title":"npj Digit. Med."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"269","DOI":"10.3233\/JPD-230181","article-title":"Kinematic effects of combined subthalamic and dorsolateral nigral deep brain stimulation in Parkinson\u2019s disease","volume":"14","author":"Kroneberg","year":"2024","journal-title":"J. Parkinsons Dis."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s12874-015-0055-5","article-title":"Simulation-based estimation of mean and standard deviation for meta-analysis via approximate Bayesian computation (ABC)","volume":"15","author":"Kwon","year":"2015","journal-title":"BMC Med. Res. Methodol."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"2055","DOI":"10.1016\/S0140-6736(09)60492-X","article-title":"Parkinson\u2019s disease","volume":"373","author":"Lees","year":"2009","journal-title":"Lancet"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1111\/biom.12543","article-title":"Alternative measures of between-study heterogeneity in meta-analysis: reducing the impact of outlying studies","volume":"73","author":"Lin","year":"2017","journal-title":"Biometrics"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1038\/s41531-021-00209-3","article-title":"Lateralized effects of deep brain stimulation in Parkinson\u2019s disease: evidence and controversies","volume":"7","author":"Lin","year":"2021","journal-title":"npj Parkinsons Dis."},{"key":"ref52","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1002\/mds.28953","article-title":"Lateralized subthalamic stimulation for axial dysfunction in Parkinson\u2019s disease: a randomized trial","volume":"37","author":"Lizarraga","year":"2022","journal-title":"Mov. Disord."},{"key":"ref53","doi-asserted-by":"publisher","first-page":"1652","DOI":"10.1007\/s00415-016-8191-3","article-title":"Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation on gait kinematics in Parkinson\u2019s disease: a randomized, blinded study","volume":"263","author":"Lizarraga","year":"2016","journal-title":"J. Neurol."},{"key":"ref54","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/j.parkreldis.2018.05.027","article-title":"Age-related selection bias in Parkinson\u2019s disease research: are we recruiting the right participants?","volume":"55","author":"Macleod","year":"2018","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref55","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1002\/mds.27709","article-title":"Clinical and methodological challenges for assessing freezing of gait: future perspectives","volume":"34","author":"Mancini","year":"2019","journal-title":"Mov. Disord."},{"key":"ref56","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1002\/jrsm.1667","article-title":"Sensitivity analysis for the interactive effects of internal bias and publication bias in meta-analyses","volume":"15","author":"Mathur","year":"2024","journal-title":"Res. Synth. Methods"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1111\/rssc.12440","article-title":"Sensitivity analysis for publication bias in meta-analyses","volume":"69","author":"Mathur","year":"2020","journal-title":"J. R. Stat. Soc. C"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1186\/s12913-014-0579-0","article-title":"PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews","volume":"14","author":"Methley","year":"2014","journal-title":"BMC Health Serv. Res."},{"key":"ref59","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1016\/S1474-4422(19)30044-4","article-title":"Gait impairments in Parkinson\u2019s disease","volume":"18","author":"Mirelman","year":"2019","journal-title":"Lancet Neurol."},{"key":"ref60","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1212\/wnl.59.5.706","article-title":"The impact on Parkinson\u2019s disease of electrical parameter settings in STN stimulation","volume":"59","author":"Moro","year":"2002","journal-title":"Neurology"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1136\/jnnp-2013-307511","article-title":"Low-frequency versus high-frequency stimulation of the pedunculopontine nucleus area in Parkinson\u2019s disease: a randomised controlled trial","volume":"86","author":"Nosko","year":"2015","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1016\/S1474-4422(11)70143-0","article-title":"Freezing of gait: moving forward on a mysterious clinical phenomenon","volume":"10","author":"Nutt","year":"2011","journal-title":"Lancet Neurol."},{"key":"ref63","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1007\/s00702-024-02778-y","article-title":"Investigation of the nonmotor symptoms in patients with STN-DBS therapy in comparison with those without STN-DBS","volume":"131","author":"Onder","year":"2024","journal-title":"J. Neural Transm."},{"key":"ref64","doi-asserted-by":"publisher","first-page":"n160","DOI":"10.1136\/bmj.n160","article-title":"PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"941","DOI":"10.2165\/11537810-000000000-00000","article-title":"Dopamine receptor agonists for the treatment of early or advanced Parkinson\u2019s disease","volume":"24","author":"Perez-Lloret","year":"2010","journal-title":"CNS Drugs"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.3233\/JPD-213119","article-title":"A randomized, double-blinded crossover trial of short versus conventional pulse width subthalamic deep brain stimulation in Parkinson\u2019s disease","volume":"12","author":"Petry-Schmelzer","year":"2022","journal-title":"J. Parkinsons Dis."},{"key":"ref67","doi-asserted-by":"publisher","first-page":"3592","DOI":"10.1093\/brain\/awz285","article-title":"Non-motor outcomes depend on location of neurostimulation in Parkinson\u2019s disease","volume":"142","author":"Petry-Schmelzer","year":"2019","journal-title":"Brain"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1111\/j.1468-1331.2008.02056.x","article-title":"Non-motor symptoms in Parkinson\u2019s disease","volume":"15","author":"Poewe","year":"2008","journal-title":"Eur. J. Neurol."},{"key":"ref69","doi-asserted-by":"publisher","first-page":"1583","DOI":"10.1002\/mds.25945","article-title":"The prevalence of Parkinson\u2019s disease: a systematic review and meta-analysis","volume":"29","author":"Pringsheim","year":"2014","journal-title":"Mov. Disord."},{"key":"ref70","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.1002\/mds.29160","article-title":"Device-assisted and neuromodulatory therapies for Parkinson\u2019s disease: a network meta-analysis","volume":"37","author":"Rajan","year":"2022","journal-title":"Mov. Disord."},{"key":"ref71","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1002\/ana.10513","article-title":"Limitations of current Parkinson\u2019s disease therapy","volume":"53","author":"Rascol","year":"2003","journal-title":"Ann. Neurol."},{"key":"ref72","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1002\/acn3.168","article-title":"Short pulse width widens the therapeutic window of subthalamic neurostimulation","volume":"2","author":"Reich","year":"2015","journal-title":"Ann. Clin. Transl. Neurol."},{"key":"ref73","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1111\/bmsp.12092","article-title":"Analysis of categorical moderators in mixed-effects meta-analysis: consequences of using pooled versus separate estimates of the residual between-studies variances","volume":"70","author":"Rubio-Aparicio","year":"2017","journal-title":"Br. J. Math. Stat. Psychol."},{"key":"ref74","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1186\/s12874-020-01075-y","article-title":"The statistical importance of a study for a network meta-analysis estimate","volume":"20","author":"Rucker","year":"2020","journal-title":"BMC Med. Res. Methodol."},{"key":"ref75","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12874-015-0060-8","article-title":"Ranking treatments in frequentist network meta-analysis works without resampling methods","volume":"15","author":"Rucker","year":"2015","journal-title":"BMC Med. Res. Methodol."},{"key":"ref76","doi-asserted-by":"publisher","first-page":"429","DOI":"10.7326\/0003-4819-157-6-201209180-00537","article-title":"Influence of reported study design characteristics on intervention effect estimates from randomized, controlled trials","volume":"157","author":"Savovic","year":"2012","journal-title":"Ann. Intern. Med."},{"key":"ref77","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1111\/ene.13167","article-title":"Effect of high-frequency subthalamic neurostimulation on gait and freezing of gait in Parkinson\u2019s disease: a systematic review and meta-analysis","volume":"24","author":"Schlenstedt","year":"2017","journal-title":"Eur. J. Neurol."},{"key":"ref78","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1007\/s00702-024-02773-3","article-title":"Advanced therapies in Parkinson\u2019s disease: an individualized approach to their indication","volume":"131","author":"Schroter","year":"2024","journal-title":"J. Neural Transm. (Vienna)"},{"key":"ref79","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.3233\/JPD-202492","article-title":"Short pulse and conventional deep brain stimulation equally improve the parkinsonian gait disorder","volume":"11","author":"Seger","year":"2021","journal-title":"J. Parkinsons Dis."},{"key":"ref80","doi-asserted-by":"publisher","first-page":"g7647","DOI":"10.1136\/bmj.g7647","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation","volume":"349","author":"Shamseer","year":"2015","journal-title":"BMJ"},{"key":"ref81","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1002\/jrsm.1369","article-title":"The value of a second reviewer for study selection in systematic reviews","volume":"10","author":"Stoll","year":"2019","journal-title":"Res. Synth. Methods"},{"key":"ref82","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1177\/135581969900400112","article-title":"Systematic reviews and meta-analysis: a structured review of the methodological literature","volume":"4","author":"Sutton","year":"1999","journal-title":"J. Health Serv. Res. Policy"},{"key":"ref83","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1136\/pgmj.2009.090456","article-title":"Freezing of gait in older people: associated conditions, clinical aspects, assessment and treatment","volume":"86","author":"Thanvi","year":"2010","journal-title":"Postgrad. Med. J."},{"key":"ref84","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1016\/S1474-4422(21)00030-2","article-title":"Challenges in the diagnosis of Parkinson\u2019s disease","volume":"20","author":"Tolosa","year":"2021","journal-title":"Lancet Neurol."},{"key":"ref85","doi-asserted-by":"publisher","first-page":"e2238","DOI":"10.1212\/WNL.0000000000006643","article-title":"Levodopa-induced dyskinesia in Parkinson disease: a population-based cohort study","volume":"91","author":"Turcano","year":"2018","journal-title":"Neurology"},{"key":"ref86","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1093\/ije\/dys041","article-title":"Predicting the extent of heterogeneity in meta-analysis, using empirical data from the Cochrane database of systematic reviews","volume":"41","author":"Turner","year":"2012","journal-title":"Int. J. Epidemiol."},{"key":"ref87","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.parkreldis.2018.09.008","article-title":"Simultaneous low-frequency deep brain stimulation of the substantia nigra pars reticulata and high-frequency stimulation of the subthalamic nucleus to treat levodopa unresponsive freezing of gait in Parkinson\u2019s disease: a pilot study","volume":"60","author":"Valldeoriola","year":"2019","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref88","doi-asserted-by":"publisher","first-page":"2482","DOI":"10.1016\/j.clinph.2018.07.013","article-title":"Decreasing subthalamic deep brain stimulation frequency reverses cognitive interference during gait initiation in Parkinson\u2019s disease","volume":"129","author":"Varriale","year":"2018","journal-title":"Clin. Neurophysiol."},{"key":"ref89","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1016\/j.jclinepi.2013.11.003","article-title":"Subgroup analysis in randomized controlled trials appeared to be dependent on whether relative or absolute effect measures were used","volume":"67","author":"Venekamp","year":"2014","journal-title":"J. Clin. Epidemiol."},{"key":"ref90","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1159\/000068959","article-title":"Deep brain stimulation for Parkinson\u2019s disease. A critical re-evaluation of STN versus GPi DBS","volume":"78","author":"Vitek","year":"2002","journal-title":"Stereotact. Funct. Neurosurg."},{"key":"ref91","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s12874-018-0483-0","article-title":"Dealing with missing standard deviation and mean values in meta-analysis of continuous outcomes: a systematic review","volume":"18","author":"Weir","year":"2018","journal-title":"BMC Med. Res. Methodol."},{"key":"ref92","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1093\/brain\/awz314","article-title":"Freezing of gait: understanding the complexity of an enigmatic phenomenon","volume":"143","author":"Weiss","year":"2020","journal-title":"Brain"},{"key":"ref93","doi-asserted-by":"publisher","first-page":"2098","DOI":"10.1093\/brain\/awt122","article-title":"Nigral stimulation for resistant axial motor impairment in Parkinson\u2019s disease? A randomized controlled trial","volume":"136","author":"Weiss","year":"2013","journal-title":"Brain"},{"key":"ref94","doi-asserted-by":"publisher","first-page":"1515","DOI":"10.1007\/s00415-015-7744-1","article-title":"PPNa-DBS for gait and balance disorders in Parkinson\u2019s disease: a double-blind, randomised study","volume":"262","author":"Welter","year":"2015","journal-title":"J. Neurol."},{"key":"ref95","doi-asserted-by":"publisher","first-page":"fcaf266","DOI":"10.1093\/braincomms\/fcaf266","article-title":"Beta burst-driven adaptive deep brain stimulation for gait impairment and freezing of gait in Parkinson\u2019s disease","volume":"7","author":"Wilkins","year":"2025","journal-title":"Brain Commun."},{"key":"ref96","doi-asserted-by":"publisher","first-page":"2430","DOI":"10.3390\/biomedicines13102430","article-title":"Deep brain stimulation for Parkinson\u2019s disease\u2014a narrative review","volume":"13","author":"Wojcik","year":"2025","journal-title":"Biomedicine"},{"key":"ref97","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1136\/jnnp-2018-318060","article-title":"Long-term effect of low frequency stimulation of STN on dysphagia, freezing of gait and other motor symptoms in PD","volume":"89","author":"Xie","year":"2018","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref98","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s40035-017-0083-7","article-title":"Effect of low versus high frequency stimulation on freezing of gait and other axial symptoms in Parkinson patients with bilateral STN DBS: a mini-review","volume":"6","author":"Xie","year":"2017","journal-title":"Transl. Neurodegener."},{"key":"ref99","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1212\/WNL.0000000000001184","article-title":"Low-frequency stimulation of STN-DBS reduces aspiration and freezing of gait in patients with PD","volume":"84","author":"Xie","year":"2015","journal-title":"Neurology"},{"key":"ref100","doi-asserted-by":"publisher","first-page":"1527020","DOI":"10.3389\/fneur.2025.1527020","article-title":"Quantitative analysis of gait parameters in Parkinson\u2019s disease and the clinical significance","volume":"16","author":"Yin","year":"2025","journal-title":"Front. Neurol."},{"key":"ref101","doi-asserted-by":"publisher","first-page":"105372","DOI":"10.1016\/j.nbd.2021.105372","article-title":"Local field potentials in Parkinson\u2019s disease: a frequency-based review","volume":"155","author":"Yin","year":"2021","journal-title":"Neurobiol. Dis."},{"key":"ref102","doi-asserted-by":"publisher","first-page":"1648","DOI":"10.1016\/j.apmr.2006.09.012","article-title":"Agreement between the GAITRite walkway system and a stopwatch-footfall count method for measurement of temporal and spatial gait parameters","volume":"87","author":"Youdas","year":"2006","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref103","doi-asserted-by":"publisher","first-page":"1597","DOI":"10.1017\/S104161021600096X","article-title":"Management of impulse control disorders in Parkinson\u2019s disease","volume":"28","author":"Zhang","year":"2016","journal-title":"Int. Psychogeriatr."}],"container-title":["Frontiers in Aging Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2025.1723706\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T06:53:45Z","timestamp":1769064825000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2025.1723706\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,22]]},"references-count":103,"alternative-id":["10.3389\/fnagi.2025.1723706"],"URL":"https:\/\/doi.org\/10.3389\/fnagi.2025.1723706","relation":{},"ISSN":["1663-4365"],"issn-type":[{"value":"1663-4365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,22]]},"article-number":"1723706"}}