Brain stimulation · 2026
Subthalamic DBS Engages Right-lateralized Frontal Control to Improve Gait Adaptation in Parkinson's Disease.
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Hanafi Ibrahem, Pozzi Nicolo G, Habib Rita, Falciglia Salvatore, Del Vecchio Del Vecchio Jasmin, Remore Luigi Gianmaria, Marotta Giorgio, Buck Andreas, Pezzoli Gianni, Volkmann Jens, Isaias Ioannis U, Palmisano Chiara
Аннотация
BACKGROUND: Successful walking requires continuous adaptation to changing environmental demands, a process that is frequently impaired in Parkinson's disease (PD). The neural mechanisms by which subthalamic nucleus deep brain stimulation (STN-DBS) modulates adaptive gait control remain unclear.
OBJECTIVE: To characterize the clinical, kinematic, metabolic, and cortical electrophysiological correlates of gait adaptation in PD and their modulation by STN-DBS during dynamic obstacle avoidance.
METHODS: We evaluated gait-adaptation kinematics and electroencephalography (EEG) in twelve PD patients during an immersive virtual-reality overground walking task under active and paused STN-DBS. Brain metabolism was assessed with three [18F]fluorodeoxyglucose positron-emission tomography scans acquired after rest and after gait adaptation under paused and active STN-DBS. Eight age-matched healthy participants completed the same gait-adaptation task for comparative kinematic analyses.
RESULTS: During gait adaptation with paused stimulation, patients showed increased metabolic activity in the cerebellum and sensorimotor cortex. Active STN-DBS selectively increased thalamic and superior frontal gyrus (SFG) metabolism while reducing cerebellar uptake. Right-lateralized SFG metabolism correlated with gait adaptation performance, and DBS-induced shifts toward greater right SFG activity were associated with gait adaptation improvement. This association was independent of baseline clinical asymmetry, electrode location, and structural connectivity to the SFG. STN-DBS amplitude asymmetry independently predicted right-lateralized SFG metabolism. EEG provided complementary evidence of lateralized network modulation, with frontal theta-band asymmetry paralleling the PET findings.
CONCLUSION: Our findings suggest that gait adaptation in PD is associated with lateralized thalamo-cortical activity involving the SFG, while STN-DBS modulates activity within this network, informing mechanisms of gait control and future image-guided programming.
OBJECTIVE: To characterize the clinical, kinematic, metabolic, and cortical electrophysiological correlates of gait adaptation in PD and their modulation by STN-DBS during dynamic obstacle avoidance.
METHODS: We evaluated gait-adaptation kinematics and electroencephalography (EEG) in twelve PD patients during an immersive virtual-reality overground walking task under active and paused STN-DBS. Brain metabolism was assessed with three [18F]fluorodeoxyglucose positron-emission tomography scans acquired after rest and after gait adaptation under paused and active STN-DBS. Eight age-matched healthy participants completed the same gait-adaptation task for comparative kinematic analyses.
RESULTS: During gait adaptation with paused stimulation, patients showed increased metabolic activity in the cerebellum and sensorimotor cortex. Active STN-DBS selectively increased thalamic and superior frontal gyrus (SFG) metabolism while reducing cerebellar uptake. Right-lateralized SFG metabolism correlated with gait adaptation performance, and DBS-induced shifts toward greater right SFG activity were associated with gait adaptation improvement. This association was independent of baseline clinical asymmetry, electrode location, and structural connectivity to the SFG. STN-DBS amplitude asymmetry independently predicted right-lateralized SFG metabolism. EEG provided complementary evidence of lateralized network modulation, with frontal theta-band asymmetry paralleling the PET findings.
CONCLUSION: Our findings suggest that gait adaptation in PD is associated with lateralized thalamo-cortical activity involving the SFG, while STN-DBS modulates activity within this network, informing mechanisms of gait control and future image-guided programming.