Short answer: Yes, in some patients; however, the effect of deep brain stimulation on walking is not as predictable as its effect on hand tremor or muscle stiffness.
In Parkinson’s disease, “walking problems” may refer to different symptoms. Shortened steps, difficulty starting to walk, the feeling that the feet are stuck to the floor, freezing when turning, imbalance, and a tendency to fall do not arise through the same mechanism. Therefore, deep brain stimulation should not be expected to improve all of these symptoms to the same extent.
What is freezing of gait?
Freezing of gait is a condition in which the patient is unable to move their feet forward for a short period of time despite wanting to walk. Patients often describe it as “my feet are stuck to the floor.”
Freezing may occur especially:
- -When starting to walk,
- -When turning,
- -When passing through a narrow space or doorway,
- -When approaching a destination,
- -In crowded or stressful environments,
- -When engaged in another task at the same time
.
Even if freezing lasts only a few seconds, it can cause loss of balance and falls. It can also significantly limit the patient’s ability to go outside alone, perform daily activities, and remain independent.
Which walking problems may respond better to deep brain stimulation?
Deep brain stimulation may be effective for symptoms of Parkinson’s disease such as slowness of movement, muscle stiffness, tremor, and “off periods” caused by the wearing off of medication effects during the day.
If walking difficulty and freezing occur particularly during off periods, when medication effects are reduced, and improve significantly after taking levodopa, the likelihood of benefiting from deep brain stimulation is generally higher. Previous studies have shown that the preoperative levodopa response is important in predicting how walking will respond to DBS. [1]
In a secondary analysis of the EARLYSTIM study, among patients with Parkinson’s disease and early motor complications, the proportion of patients experiencing freezing of gait decreased from 52% to 34% in the DBS group during two years of follow-up, while no significant change was observed in the group receiving medication alone. [2]
However, this result does not mean that deep brain stimulation will improve every type of freezing. By reducing off periods, DBS may also reduce freezing that occurs during these periods in some patients. Freezing that persists during the on period, when medication is effective, and balance impairment that becomes prominent in advanced stages may show a more limited or variable response.
What does the research show?
A recent systematic review and meta-analysis published in 2026, evaluating a total of 905 patients across 31 studies, showed a modest average improvement in scales assessing freezing of gait after DBS. However, the results varied substantially according to the brain region stimulated, the frequency used, and whether the assessment was performed during the medicated or unmedicated state. [3]
The most important message of these findings is that there is no single answer applicable to all patients, such as “DBS improves freezing” or “DBS is ineffective for freezing.” The type of freezing and the circumstances in which it occurs should be evaluated in detail.
Why might walking not improve sufficiently after deep brain stimulation?
Walking is not a simple movement controlled by only one area of the brain. It requires initiation of movement, maintenance of rhythm, balance, attention, visual perception, and adaptation to environmental conditions.
Therefore, the outcome may be more limited in the following situations:
- -Freezing persists during the on period independently of medication,
- -There is significant loss of balance and frequent falls,
- -Attention and planning during walking are significantly affected,
- -Axial symptoms associated with advanced-stage disease are predominant,
- -There are orthopedic, spinal, or peripheral nerve problems in addition to Parkinson’s disease,
- -Device settings and medications have not been adjusted appropriately for the patient’s needs.
DBS does not completely eliminate Parkinson’s disease and does not stop the natural progression of the disease. In the years after surgery, new walking and balance problems may emerge due to disease progression.
Can walking worsen after deep brain stimulation?
Although this is not expected in every patient, walking or balance problems may develop or become more pronounced after surgery in some patients.
A systematic review published in 2025 evaluated studies reporting worsening of walking and balance after bilateral subthalamic nucleus stimulation. In controlled consecutive patient cohorts, this was reported in 15.9% of patients treated with DBS and 5.8% of patients receiving best medical therapy. However, because there were important methodological differences among the studies, these rates cannot be directly applied to every patient. [4]
Worsening of walking is not always a direct result of surgery. Disease progression, excessive reduction of medications, stimulation affecting unintended neural pathways, or inappropriate programming settings may also play a role. Therefore, postoperative follow-up is not complete simply by turning on the device.
How is the preoperative evaluation performed?
The decision to proceed with deep brain stimulation is not made solely based on the diagnosis of Parkinson’s disease or the duration of the disease. Especially when expectations related to walking are involved, it is important to answer the following questions:
- -Does freezing occur during the off period, when medication effects are reduced, or during the on period?
- -To what extent do step length, walking speed, and freezing change after taking levodopa?
- -Under what circumstances does the patient fall?
- -Are there significant balance, speech, or cognitive problems?
- -What is the patient’s primary expectation from DBS?
- -Have the symptoms expected and not expected to improve been explained to the patient realistically?
In an ideal evaluation, the patient’s motor examinations during medicated and unmedicated periods are compared. In patients who require it, a detailed walking assessment, neuropsychological evaluation, and brain imaging are performed. It is important that patient selection be carried out by an experienced team in which specialists in neurology, functional neurosurgery, psychiatry, or neuropsychology work together. [5]
Why is programming important?
Correct electrode placement is one of the fundamental requirements of treatment; however, it is not sufficient on its own. The direction, intensity, frequency, and duration of electrical stimulation are adjusted for each patient.
In some patients, tremor may improve rapidly during initial programming, whereas finding the optimal settings for walking may take longer. While standard high-frequency stimulation reduces slowness of movement and stiffness, different frequencies or stimulation patterns may be tried in selected patients.
When making adjustments, having the patient walk only a few steps in the examination room may not be sufficient. Turning, narrow spaces, starting to walk, dual-tasking, and the conditions that the patient finds challenging in daily life should also be assessed as much as possible.
Can adaptive DBS improve walking more effectively?
Most systems used today continuously deliver predetermined electrical stimulation. Adaptive DBS systems, on the other hand, aim to adjust stimulation according to need by monitoring electrical signals in the brain or the patient’s movement.
Small and experimental studies evaluating adaptive DBS systems that deliver stimulation according to the phase of gait have reported improvements in some walking measures. [6] Another early-stage study that automatically adjusted stimulation using beta activity in the brain also observed positive results for walking and freezing. [7]
However, these studies include small numbers of patients, and some are preliminary studies that have not yet been published in a peer-reviewed journal. Therefore, it cannot yet be concluded that adaptive DBS is a standard and proven treatment for freezing of gait.
Conclusion
Deep brain stimulation can reduce off periods, slowness of movement, and some medication-responsive walking problems in appropriately selected patients with Parkinson’s disease. The likelihood of benefit is higher particularly for freezing that occurs during the off period and improves with levodopa.
In contrast, freezing that persists during the on period, advanced balance impairment, and axial symptoms related to disease progression may have a more variable response. The success of treatment depends not only on surgery, but also on appropriate patient selection, electrode placement, device programming, medication adjustments, and long-term follow-up.
Therefore, before surgery, the question “Will deep brain stimulation improve my walking?” should be preceded by the question, “What type of walking problem am I experiencing, and how does this symptom respond to levodopa?”
This article has been prepared for general informational purposes. It does not replace personalized diagnosis or treatment recommendations.
References
- 1. Schlenstedt C, Shalash A, Muthuraman M, Falk D, Witt K, Deuschl G. Effect of high-frequency subthalamic neurostimulation on gait and freezing of gait in Parkinson’s disease: a systematic review and meta-analysis. European Journal of Neurology. 2017;24(1):18–26.
- 2. Barbe MT, Tonder L, Krack P, et al. Deep Brain Stimulation for Freezing of Gait in Parkinson’s Disease With Early Motor Complications. Movement Disorders. 2020;35(1):82–90.
- 3. Behboodi M, Abdollahifard S, Assadian K, et al. Deep brain stimulation for freezing of gait in Parkinson’s disease: An updated systematic review, meta-analysis, and a single-center clinical experience. Neurosurgical Review. 2026;49(1):397.
- 4. Janssen Daalen JM, Selvaraj A, Arnts H, et al. Gait and balance worsening after bilateral deep brain stimulation of the subthalamic nucleus for Parkinson’s disease: a systematic review. BMJ Neurology Open. 2025;7(1):e000898.
- 5. Pollak P. Deep brain stimulation for Parkinson’s disease—patient selection. Handbook of Clinical Neurology. 2013;116:97–105. PubMed
- 6. Louie KH, Balakid JP, Bath JE, et al. Adaptive deep brain stimulation timed to gait phase improves walking in Parkinson’s disease. medRxiv. 2025.
- 7. Wilkins KB, Petrucci MN, Lambert EF, et al. Beta Burst-Driven Adaptive Deep Brain Stimulation Improves Gait Impairment and Freezing of Gait in Parkinson’s Disease. medRxiv. 2024.