Multimodal mapping of balance dysfunction in Parkinson's disease: a consensus roadmap for research and intervention

PURPOSE OF REVIEW: Balance depends on accurate perception of self-motion and verticality and on multisensory integration for stance, and gait. In Parkinson's disease, balance is commonly impaired and variably affected by treatment. Although vestibular and multisensory contributions are increasingly recognized, progress is limited by fragmented evidence, inconsistent methods, and artifact-prone measures. We provide a consensus roadmap across four domains - video-oculography/vHIT, VEMPs, posturography, and perceptual paradigms - to improve clinical translation of balance research in Parkinson's disease. RECENT FINDINGS: An interdisciplinary taskforce conducted a comprehensive literature review and a modified Delphi process (≥80% agreement), using virtual meetings, surveys, and an in-person consensus session. Oculography/vHIT shows largely preserved aVOR in Parkinson's disease but is vulnerable to Parkinson's disease specific artifacts, requiring standardization. VEMPs relate to brainstem and non-motor features but are limited by EMG-dependent confounds. Posturography reveals impaired multisensory integration with visual dependence and cholinergic contributions; reactive-capacity measures outperform sway alone. Perceptual paradigms show task-specific distortions and increased variability linked to axial/postural syndromes. SUMMARY: This consensus offers a practical roadmap, de-emphasize aVOR/vHIT as primary unsteadiness outcomes; use VEMPs as ancillary measures; prioritize posturography probing adaptability and reactive stepping; integrate wearables and neurochemical imaging; and adopt consortium-level minimum datasets to enable reproducible, phenotype-aware advances in Parkinson's disease balance research.

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Publication Details

Journal
Current Opinion in Neurology
Published
2026-06-17
DOI
https://doi.org/10.1097/wco.0000000000001502
Primary Topic
Balance, Gait, and Falls Prevention
Type
article
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article

Multimodal mapping of balance dysfunction in Parkinson's disease: a consensus roadmap for research and intervention

Nicholas D’Cruz, Caroline Paquette, Alessandro Gulberti, Sanjay Pandey et al.
Current Opinion in Neurology
Balance, Gait, and Falls Prevention
article

Multimodal mapping of balance dysfunction in Parkinson's disease: a consensus roadmap for research and intervention

Nicholas D’Cruz, Caroline Paquette, Alessandro Gulberti, Sanjay Pandey, Stewart A. Factor, Tuhin Virmani, Mihalis Doumas, William Young, Martina Mancini, Vivian Weerdesteyn, Mark G. Carpenter, Chrystalina Antoniades, Qadeer Arshad, Janet Rucker, Adolfo M. Bronstein, Barry Seemungal, Alfonso Fasano, Nicolass Bohnen, Kailash Bhatia, Jeffrey Hausdorf, Diego Kaski, Bastiaan Bloem, Aasef G. Shaikh
article en

Abstract

PURPOSE OF REVIEW: Balance depends on accurate perception of self-motion and verticality and on multisensory integration for stance, and gait. In Parkinson's disease, balance is commonly impaired and variably affected by treatment. Although vestibular and multisensory contributions are increasingly recognized, progress is limited by fragmented evidence, inconsistent methods, and artifact-prone measures. We provide a consensus roadmap across four domains - video-oculography/vHIT, VEMPs, posturography, and perceptual paradigms - to improve clinical translation of balance research in Parkinson's disease. RECENT FINDINGS: An interdisciplinary taskforce conducted a comprehensive literature review and a modified Delphi process (≥80% agreement), using virtual meetings, surveys, and an in-person consensus session. Oculography/vHIT shows largely preserved aVOR in Parkinson's disease but is vulnerable to Parkinson's disease specific artifacts, requiring standardization. VEMPs relate to brainstem and non-motor features but are limited by EMG-dependent confounds. Posturography reveals impaired multisensory integration with visual dependence and cholinergic contributions; reactive-capacity measures outperform sway alone. Perceptual paradigms show task-specific distortions and increased variability linked to axial/postural syndromes. SUMMARY: This consensus offers a practical roadmap, de-emphasize aVOR/vHIT as primary unsteadiness outcomes; use VEMPs as ancillary measures; prioritize posturography probing adaptability and reactive stepping; integrate wearables and neurochemical imaging; and adopt consortium-level minimum datasets to enable reproducible, phenotype-aware advances in Parkinson's disease balance research.

Current Opinion in Neurology
Rush University Medical Center (US), University College Hospital (GB), Humanitas University (IT), University College London Hospitals NHS Foundation Trust (GB), University of British Columbia (CA), Radboud University Nijmegen (NL), Emory University (US), University of Leicester (GB), Universität Hamburg (DE), Oregon Health & Science University (US), Queen Mary University of London (GB), King's College London (GB), University of Exeter (GB), University of Michigan (US), University Hospitals of Cleveland (US), University of Arkansas Medical Center (US), Tel Aviv Sourasky Medical Center (IL), John Radcliffe Hospital (GB), Radboud University Medical Center (NL), Grade Medical (Czechia) (CZ), Cleveland FES Center (US), VA Ann Arbor Healthcare System (US), University Medical Center Hamburg-Eppendorf (DE), NIHR Imperial Biomedical Research Centre (GB), Michigan Medicine (US), Asian Institute of Medical Sciences (IN), Institute for Advanced Study (DE), University Radiology (US), Department of Veterans Affairs (AU), National Hospital for Neurology and Neurosurgery (GB), IRCCS Humanitas Research Hospital (IT), University College London (GB), Imperial College London (GB), McGill University (CA), New York University (US), Case Western Reserve University (US), University of Arkansas for Medical Sciences (US), KU Leuven (BE)
Openalex Percentile: Top 4%
Balance, Gait, and Falls Prevention
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