Journal of Movement Disorders

Original Articles

Connectivity-Based Analysis of the Stimulation Effects of Globus Pallidus Interna Deep Brain Stimulation in Parkinson’s Disease: A Focus on Freezing of Gait: Sungyang Jo, Moongwan Choi, Jihyun Lee, Sangjin Lee, Hwon Heo, Chong Hyun Suh, Woo Hyun Shim, Junhyung Kim, Sang Ryong Jeon, Hyunna Lee, Sun Ju Chung; J Mov Disord. 2025;18(4):327-336. Published online July 30, 2025; DOI: https://doi.org/10.14802/jmd.25005

3,999 View
119 Download
1 Web of Science
1 Crossref

Objective
Freezing of gait (FOG) significantly affects quality of life and increases the risk of falls in patients with Parkinson’s disease (PD). Although deep brain stimulation (DBS) of the globus pallidus interna (GPi) is effective in managing motor complications, its efficacy in treating FOG remains inconsistent. This study aimed to determine whether preoperative structural brain connectivity can predict both the presence of FOG and its postoperative improvement following GPi DBS.
Methods
We retrospectively analyzed 58 patients with PD who underwent GPi DBS. Preoperative diffusion tensor imaging was used to assess structural connectivity between the volume of activated tissue (VAT) and 82 cortical regions. Machine learning models were developed to predict baseline FOG and postoperative FOG improvement (defined as a ≥1- or ≥2-point reduction) using demographic and connectivity features.
Results
Machine learning models incorporating structural connectivity features between the VAT and cortical regions—including the prefrontal, cingulate, and premotor cortices—outperformed models based solely on demographic variables in predicting both the presence of preoperative FOG and postoperative improvement. For example, the support vector machine model to predict FOG improvement (≥1-point improvement) achieved an accuracy of 0.65 with demographic data alone, which increased to 0.77 with the addition of structural connectivity features. Similar performance enhancements were observed in sensitivity analyses using stricter FOG thresholds (≥2-point improvement).
Conclusion
Preoperative structural connectivity between the GPi and key cortical regions involved in cognitive control and motor planning predicts FOG responsiveness to DBS. These results highlight the utility of connectomic biomarkers for personalizing DBS strategies and optimizing therapeutic outcomes in patients with advanced PD.

Citations

Citations to this article as recorded by

Predictors of motor outcome with pallidal stimulation for Parkinson’s disease from the CSP468 cohort
Shawn D’Souza, Aashish Batheja, Jeffrey Chen, Harsh P. Shah, Vikram Seshadri, Nina Opem, Omar Al-Dulaimi, Jamie Toms, Pierre D’Haese, Benoit M. Dawant, Rui Li, Paul Koch, Paul Larson, Kathryn L. Holloway
npj Parkinson's Disease.2026;[Epub] CrossRef

Long-term Effects of Bilateral Subthalamic Deep Brain Stimulation on Postural Instability and Gait Difficulty in Patients with Parkinson’s Disease: Hae-Won Shin, Mi Sun Kim, Sung Reul Kim, Sang Ryong Jeon, Sun Ju Chung; J Mov Disord. 2020;13(2):127-132. Published online May 29, 2020; DOI: https://doi.org/10.14802/jmd.19081

9,658 View
233 Download
16 Web of Science
15 Crossref

Abstract PDF

Objective
The long-term effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on postural instability and gait difficulty (PIGD) in patients with Parkinson’s disease (PD) remain unclear. In this study, we aimed to evaluate the longterm effects of STN-DBS surgery on PIGD symptoms in patients with advanced-stage PD. Methods This study included 49 consecutively included patients with PD who underwent bilateral STN-DBS. The Unified Parkinson’s Disease Rating Scale (UPDRS) scores and subscores for PIGD were assessed at baseline and at 1, 3, and 5 years postoperatively. The PIGD subscore was divided into PIGD-motor and PIGD-activities of daily living (ADL) scores according to parts III and II of the UPDRS, respectively. Results The PIGD-motor and PIGD-ADL scores at the “medication-off” state improved at 3 and 5 years, respectively. Overall, the UPDRS III and II scores at “medication-off” improved at 5 years. The UPDRS IV score also significantly improved and the levodopa equivalent daily dosage decreased at all follow-ups. Finally, the PIGD-motor score at baseline was able to predict long-term improvement in the PIGD-motor score at the 5-year follow-up. Conclusion The STN-DBS has both short- and long-term effects on PIGD, as well as overall motor function, in patients with advanced PD. The degree of PIGD at the preoperative evaluation can be used to predict long-term outcomes after STN-DBS surgery.

Citations

Citations to this article as recorded by

Correlation of intra- and postoperative best active contact and its implication for STN-DBS outcome
Robert Nickl, Hannah Mais, Ghadir Abbas, Hazem Eldebakey, Jonas Roothans, Martin Reich, Cordula Matthies, Patrick Fricke
World Neurosurgery: X.2026; 29: 100558. CrossRef
Frequency‐ and Layer‐Specific Modulation of Cortical Neuronal Activity by Pulsed Electrical Stimulation
Xinzhi Ye, Junfeng Wang, Jiao Liu, Zepeng Liu, Yuxin Huang, Wei Li, Jiaxin Wang, Xiyao Gu, Zhiyan Wang, Linlin Sun
MedComm.2026;[Epub] CrossRef
Ventral STN stimulation is associated with improved axial motor outcomes in Parkinson’s disease
Madison Butler, Asra Askari, Brandon Zhu, Kara Wyant, Daniel Leventhal, Parag G. Patil, Kelvin L. Chou
Journal of Neural Transmission.2025; 132(7): 1031. CrossRef
Effects and mechanisms of acupuncture for PIGD-subtype Parkinson’s disease via integration of fMRI and gut microbiota-metabolomics analysis: protocol for a prospective randomized controlled trial
Jili Sheng, Yingqi Xu, Tao Liu, Jianfang Zhu, Caiyun Mu, Lihao Zhai, Shanhu Xu, Hanyi Wang, Xiangzhi Liu, Tao Liu, Xiaoqing Jin
Frontiers in Aging Neuroscience.2025;[Epub] CrossRef
Effects of subthalamic nucleus deep brain stimulation using different frequency programming paradigms on axial symptoms in advanced Parkinson’s disease
Yifeng Cheng, Guangrui Zhao, Lei Chen, Deqiu Cui, Chunjuan Wang, Keke Feng, Shaoya Yin
Acta Neurochirurgica.2024;[Epub] CrossRef
Subthalamic deep brain stimulation in advanced Parkinson’s disease using the STarFix system
Amr Elnaggar, Ahmad Elshanawany, Ahmad Ebrahim Elgheriany, Mahmoud Hasan Ragab, Ahmad Radwan Nouby
Egyptian Journal of Neurosurgery.2024;[Epub] CrossRef
Individual Structural Covariance Network Predicts Long-Term Motor Improvement in Parkinson Disease with Subthalamic Nucleus Deep Brain Stimulation
Yu Diao, Hutao Xie, Yanwen Wang, Baotian Zhao, Anchao Yang, Jianguo Zhang
American Journal of Neuroradiology.2024; 45(8): 1106. CrossRef
Circular walking is useful for assessing the risk of falls in early progressive supranuclear palsy
Masahiro Ohara, Kosei Hirata, Taiki Matsubayashi, Qingmeng Chen, Kaoru Shimano, Ryoichi Hanazawa, Akihiro Hirakawa, Takanori Yokota, Takaaki Hattori
Journal of Neurology.2024; 271(9): 6349. CrossRef
Long-term motor outcomes of deep brain stimulation of the globus pallidus interna in Parkinson's disease patients: Five-year follow-up
Yun Su Hwang, Sungyang Jo, Seung Hyun Lee, Nayoung Kim, Mi-Sun Kim, Sang Ryong Jeon, Sun Ju Chung
Journal of the Neurological Sciences.2023; 444: 120484. CrossRef
Smartwatch gait coordination index: New measure for human gait utilizing smartwatch sensor
Sumin Han, Rob Paul
Medicine.2023; 102(12): e33267. CrossRef
WITHDRAWN: Laterality and frequency settings of subthalamic nucleus DBS for Parkinson's disease: A systematic review and network meta-analysis
Rajiv Dharnipragada, Lalitha S. Denduluri, Anant Naik, Mario Bertogliat, Matthew Awad, Salman Ikramuddin, Michael C. Park
Parkinsonism & Related Disorders.2023; : 105455. CrossRef
Frequency settings of subthalamic nucleus DBS for Parkinson's disease: A systematic review and network meta-analysis
Rajiv Dharnipragada, Lalitha S. Denduluri, Anant Naik, Mario Bertogliat, Matthew Awad, Salman Ikramuddin, Michael C. Park
Parkinsonism & Related Disorders.2023; 116: 105809. CrossRef
Unlocking potential: low frequency subthalamic nucleus stimulation enhances executive function in Parkinson’s disease patients with postural instability/gait disturbance
Guofan Qin, Hutao Xie, Lin Shi, Baotian Zhao, Yifei Gan, Zixiao Yin, Yichen Xu, Xin Zhang, Yaojing Chen, Yin Jiang, Quan Zhang, Jianguo Zhang
Frontiers in Neuroscience.2023;[Epub] CrossRef
The Role of Microelectrode Recording in Deep Brain Stimulation Surgery for Parkinson’s Disease: A Systematic Review and Meta-Analysis
R. Saman Vinke, Martin Geerlings, Ashok K. Selvaraj, Dejan Georgiev, Bastiaan R. Bloem, Rianne A.J. Esselink, Ronald H.M.A. Bartels
Journal of Parkinson’s Disease.2022; 12(7): 2059. CrossRef
Axial impairment and falls in Parkinson’s disease: 15 years of subthalamic deep brain stimulation
Alessandro Zampogna, Francesco Cavallieri, Francesco Bove, Antonio Suppa, Anna Castrioto, Sara Meoni, Pierre Pélissier, Emmanuelle Schmitt, Amélie Bichon, Eugénie Lhommée, Andrea Kistner, Stephan Chabardès, Eric Seigneuret, Valerie Fraix, Elena Moro
npj Parkinson's Disease.2022;[Epub] CrossRef

First
Prev
Page of 1
Next
Last

Search