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Abstract Introduction Axial symptoms in Parkinson’s disease (PD) are challenging to treat, even with deep brain stimulation (DBS). Trans-spinal magnetic stimulation (TsMS) has emerged as a potential neuromodulatory approach for gait and balance dysfunction Methods In this randomized, double-blind, sham-controlled trial, patients with PD and DBS received active or sham TsMS for five days. The primary outcome was gait performance measured by the Timed Up and Go (TUG) test. Secondary outcomes included balance (Balance Evaluation Systems Test, BESTest), freezing of gait, motor severity (Unified Parkinson's Disease Rating Scale, part III, UPDRS-III), and quality of life scales. Results Thirty-nine patients completed the study. No significant difference was observed in TUG (p = 0.604). Improvements were noted in two BESTest subdomains: anticipatory postural adjustments (p = 0.031) and gait stability (p = 0.048), but these effects were not sustained. Conclusions Trans-spinal theta burst stimulation did not improve gait, freezing, motor severity or quality of life compared with sham. Small transient changes observed in isolated balance subdomains were exploratory, were not sustained over time, and should not be interpreted as evidence of clinical efficacy.
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