HONOLULU — Adding intermittent theta-burst trans-spinal magnetic stimulation to treadmill training is safe and improves gait and other motor symptoms in adults with Parkinson’s disease (PD), new research suggested.

In a randomized, double-blind study, patients with PD and gait impairment who underwent 10 sessions of theta burst stimulation followed by treadmill training had significantly greater change in fast gait speed (FGS) than those who received matching sham stimulation plus treadmill training, meeting the primary endpoint.

The active treatment group also showed greater improvement in Freezing of Gait Questionnaire (FoG-Q) scores, near falls, and motor experiences of daily living. In addition, there were no significant between-group differences in adverse events (AEs).

The findings were presented here on October 6 at the International Congress of Parkinson's Disease and Movement Disorders (MDS) 2025.

Need for Combo Treatments

Co-investigator Larissa Karlla Lopes, University of São Paulo, São Paulo, Brazil, told meeting attendees the investigators had sought to examine whether theta burst spinal stimulation “could enhance” the benefit treadmill training provides to gait function.

“Gait disorders are a major cause of disability in Parkinson’s, appearing early and worsening over time,” Lopes said. “Management remains challenging, requiring combined therapeutic approaches,” she added.

The researchers assessed 70 adult patients with gait impairments and PD at three research centers in Brazil between October 2022 and May 2024. 

All were randomly assigned to receive either 10 sessions of trans-spinal theta burst stimulation administered over 2 weeks followed by 30 minutes of treadmill training at progressive speeds (n = 34; median age, 62 years; 62% men) or matching sham stimulation (with the coil turned off) plus treadmill training (n = 36; median age, 59 years; 75% men). The active treatment was performed in 20 trains of 20 bursts at 5 Hz with 8-second intervals. 

Follow-up occurred 3, 15, 30, and 90 days after intervention completion. 

Results showed significantly greater change in FGS from baseline to day 3 post-intervention, as measured by the 10-m walk test, for the active treatment group compared to the sham group (P = .001).

Participants also had greater improvement in near falls (P = .004), the MDS-Unified Parkinson’s Disease Rating Scale II scores (P = .04), and FoG-Q scores (P = .046).

Significant between-group differences were observed on the FoG-Q at day 30 (-2.3; P = .002) and day 90 (-1.75; P = .02) post-intervention, as well as on Parkinson’s Disease Questionnaire 39-item mobility scores at day 30 (P = .02). While 29% of the active group reported mild, transient AEs vs 20% in the sham group, the difference was not statistically significant.

Clinically Meaningful?

Commenting for Medscape Medical News, session co-moderator Tatyana Simuni, MD, professor of neurology at Northwestern University, Chicago, Illinois, cautioned that the study didn’t appear to be “ready for prime time” yet.

“The data are interesting, but mechanistically we need to understand why spinal cord stimulation would improve the pathway involved in Parkinson’s disease,” said Simuni, who was not involved with the research.

She added that although several of the findings were statistically significant, she would like to know more about the study’s clinical meaningfulness.

The investigators and Simuni reported having no relevant financial relationships.