Letter to the editor: Acupuncture as a phenotype-specific adjunct for fear-of-falling in Parkinson's disease.

INTRODUCTION

Fear-of-falling (FoF) in Parkinson's disease (PD) is a complex symptom with heterogeneous drivers. Recent work by Onder et al. (2026) delineated three distinct FoF phenotypes, highlighting anxiety as an independent predictor and emphasizing the need for personalized therapeutic strategies beyond conventional motor-focused approaches.

METHODS

This perspective analyzes the pathophysiological rationale and existing preclinical and clinical evidence supporting acupuncture as a phenotype-specific adjunctive therapy. We evaluate evidence for its mechanisms (e.g., HPA axis modulation, dopaminergic pathway enhancement) and match these to the dominant drivers (anxiety, gait impairment, pervasive motor disability) identified in the FoF phenotypic framework.

RESULTS

Acupuncture demonstrates potential for modulating neurobiological substrates relevant to different FoF phenotypes. For the anxiety-dominant phenotype, it may alleviate symptoms via autonomic regulation. For motor-dominant phenotypes, it may improve postural stability and gait parameters, possibly through neuromodulation of motor circuits. Its favorable safety profile supports its feasibility as an adjunctive intervention.

CONCLUSION

The phenotypic model of FoF provides a critical framework for personalizing treatment. Acupuncture represents a promising, tailored adjunctive therapy targeting the specific neuropsychiatric and motor mechanisms underlying different FoF phenotypes. Future high-quality, phenotype-stratified clinical trials are warranted to evaluate its efficacy and integrate it into comprehensive PD management.