The vestibulo-ocular and vestibulospinal reflexes minimally impact the freezing of gait in patients with early-to-moderate Parkinson’s disease

Abstract

Introduction

Freezing of gait (FOG) is a disabling condition that often leads to falls and severe postural instability in patients with Parkinson’s disease (PD). This study aimed to determine whether FOG is associated with the integrity of the vestibulo-ocular (VOR) and vestibulospinal reflexes (VSR).

Methods

We retrospectively collected 138 patients with de novo PD at a tertiary medical center between February 2022 and February 2025. Each patient was queried and assessed for FOG status during the initial assessment. All patients underwent video head-impulse tests (video-HIT), cervical vestibular-evoked myogenic potential (cVEMP), ocular vestibular-evoked myogenic potential (oVEMP), and motion analysis.

Results

FOG was observed in 23 patients (23/138, 17 %). The head impulse gain of the VOR did not differ between freezers and non-freezers in any semicircular canal. The new FOG questionnaire score showed no correlation with the VOR gain for any canal. The oVEMP and cVEMP parameters did not differ between freezers and non-freezers either. Multivariable logistic regression analysis revealed a positive association between FOG and MDS-UPDRS-III (p = 0.016). However, FOG was not associated with the VOR gain in any canal or abnormalities on oVEMP or cVEMP.

Conclusions

Our preliminary data suggest that FOG is associated with the severity of motor symptoms in patients with early-to-moderate PD. While the integrity of the VOR or VSR is not currently associated with FOG, a well-designed future study could provide more nuanced insights into the relationship with these factors.