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. 2025 Jul:136:107871.
doi: 10.1016/j.parkreldis.2025.107871. Epub 2025 May 16.

Probabilistic mapping of gait changes after STN-DBS for Parkinson's disease

Robert C Nickl  1 , Hazem Eldebakey  2 , J Anne Grossmann  2 , Jonas Roothans  2 , Pavel Navrátil  2 , Ioannis U Isaias  2 , Florian Lange  2 , Patrick Fricke  1 , Philipp Capetian  2 , Cordula Matthies  1 , Jens Volkmann  2 , Martin M Reich  3
Affiliations
Free article

Probabilistic mapping of gait changes after STN-DBS for Parkinson's disease

Robert C Nickl et al. Parkinsonism Relat Disord. 2025 Jul.
Free article

Abstract

Introduction: Gait disturbances causing impaired mobility are common in Parkinson's disease after bilateral deep brain stimulation of the subthalamic nucleus. We describe subthalamic subregions where neurostimulation had a positive effect on gait or provoked gait disturbances.

Methods: 98 patients were classified according to changes in MDS-UPDRS III gait items: gait improvement (≥1-point improvement in items 3.10 and/or 3.11), gait deterioration (≥1-point worsening, confirmed by repeated clinical documentation), or no change. We performed a segregation analysis for (1) and (3) by simulating volumes of tissue activated and comparing aggregated spatial data and calculated probability maps to forecast gait performance and the parkinsonism control.

Results: 42 patients experienced improvement of presurgical gait problems after stimulation. Seven patients showed gait deteriorations one-year post-implantation. Active contacts were more ventrally located for gait deterioration versus gait improvement. Voxel-wise probabilistic mapping of gait changes in the subthalamic area were able to forecast patient specific gait performance based on individual stimulation volume (LOOCV R2 = 0.45; p < 0.01) but was not associated with long-term parkinsonism control. Whereas a probabilistic map trained on MDS-UPDRS-III changes was predictive for clinical improvement in parkinsonism (R2 = 0.18; p < 0.01).

Discussion: Probabilistic mapping showed a strong correlation with therapy outcomes, especially gait improvement, and provided predictive value at the individual level. While the concept of sweet- or sourspots was insufficient to explain individual variability, the heatmap-based approach allowed symptom-specific topographies to be identified. Our findings support the use of probabilistic mapping as a valuable tool to guide individualized reprogramming strategies for improving mobility in Parkinson's disease.

Keywords: Deep brain stimulation; Freezing of gait; Heat map; Movement disorder surgery; Parkinson's disease; Sweetspot; Volume of tissue activated.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Martin Reich reports financial support was provided by Deutsche Forschungsgemeinschaft. Martin Reich reports financial support was provided by German Parkinson Association. Robert Nickl reports a relationship with Boston Scientific Corporation that includes: funding grants. Ioannis U Isaias reports a relationship with Medtronic Inc that includes: consulting or advisory and funding grants. Ioannis U Isaias reports a relationship with Newronika that includes: consulting or advisory and funding grants. Philipp Capetian reports a relationship with Boston Scientific Corporation that includes: funding grants and speaking and lecture fees. Philipp Capetian reports a relationship with Brainlab AG that includes: funding grants and speaking and lecture fees. Cordula Matthies reports a relationship with Boston Scientific Corporation that includes: speaking and lecture fees. Jens Volkmann reports a relationship with Boston Scientific Corporation that includes: funding grants and speaking and lecture fees. Jens Volkmann reports a relationship with Medtronic Inc that includes: funding grants and speaking and lecture fees. Jens Volkmann reports a relationship with Abbott Laboratories Inc that includes: funding grants and speaking and lecture fees. Martin Reich reports a relationship with Boston Scientific Corporation that includes: funding grants and speaking and lecture fees. Martin Reich reports a relationship with Medtronic Inc that includes: funding grants and speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.