The role of electrode placement in subthalamic nucleus deep brain stimulation for improving gait in Parkinson's...

To investigate the relationship between the spatial location of active electrode contacts in subthalamic nucleus deep brain stimulation (STN-DBS) and changes in gait performance in patients with Parkinson's disease (PwPD).

This observational study included 49 PwPD who underwent bilateral STN-DBS. Spatiotemporal gait parameters were assessed before surgery and six months post-implantation using motion capture. Both mean values and variability of gait parameters were analyzed. Active contact locations were normalized using a voxel-based approach and statistically associated with gait outcomes.

STN-DBS led to significant reductions in stride time, stance time, swing time, and step time, alongside increased step width and temporal gait variability. Gait improvements were associated with specific stimulation sites: the postero-superior STN region was most effective for enhancing mean spatial parameters (e.g., stride length, walking speed), while the antero-superior region was optimal for reducing temporal variability. Patients stimulated in these regions showed significantly better gait outcomes than those stimulated elsewhere.

Gait improvements were differentially associated with the spatial location of stimulation electrode within the STN, suggesting region-specific modulation of mean spatial and temporal variability gait parameters.

These findings support precision targeting of stimulation sites to optimize patient-specific gait outcomes, advancing personalized DBS therapy in Parkinson's disease.