Objective: To investigate the clinical impact of temporally patterned deep brain stimulation (DBS) on gait and Freezing of Gait (FoG) in Parkinson’s disease (PD).

Background: Conventional continuous DBS (cDBS) effectively manages many PD motor symptoms, yet its impact on gait and FoG remains inconsistent. As locomotion requires dynamic neural coordination across cortico-subcortical networks [1-3], we hypothesize that temporally patterned stimulation better engages physiological neural dynamics and restores functional inter-hemispheric relationships.

Method: Five PD patients implanted with a Boston Scientific DBS system underwent three double-blinded sessions comparing cDBS with temporally patterned stimulation via the Chronos Research Software. The protocol involved alternating left and right brain hemispheres between full and half clinical settings, synchronized with the patient’s natural gait cycle at three levels (0.8×, 1.0×, and 1.2× gait cycle speed). Outcomes were quantified via Walking Performance Index (WPI, [4]) and Turning Performance Index (TPI, [5]), integrating multiple kinematic variables. FoG episodes were quantified during at-home testing.

Results: Patterned stimulation significantly improved gait through individualized optimization. Selecting each participant’s optimal modulation parameter (Table 1) yielded a 119.3% mean significant increase in WPI (p=0.047) compared to cDBS. While turning performance showed a positive trend (18.3% increase in TPI), it did not reach significance (p=0.19). Notably, patients with FoG (S2 & S5) showed substantial improvements in walking and turning with patterned stimulation. The best condition was subject-dependent where three patients responded robustly to amplitude alterations, while two achieved peak performance via frequency modulation. This differential responsiveness underscores the necessity and potential of patient-specific parameter optimization. S2 also demonstrated significant reduction (~59% reduction) of FoG episodes at home with patterned stimulation compared to cDBS.

Conclusion: Temporally patterned DBS enhances gait and turning in PD, revealing patient-specific responsiveness to stimulation dynamics. Our findings highlight the importance of temporal structure in neuromodulation and suggest that aligning DBS with the dynamic neural demands of locomotion is a promising strategy to address complex gait impairments, including FoG.

Table 1.

References: [1] Singh, A., Kammermeier, S., Plate, A., Mehrkens, J. H., Ilmberger, J., & Bötzel, K. (2011). Pattern of local field potential activity in the globus pallidus internum of dystonic patients during walking on a treadmill. Experimental neurology, 232(2), 162-167.
[2] Gwin, J. T., Gramann, K., Makeig, S., & Ferris, D. P. (2011). Electrocortical activity is coupled to gait cycle phase during treadmill walking. Neuroimage, 54(2), 1289-1296.
[3] Louie, K. H., Balakid, J. P., Bath, J. E., Song, S., Azgomi, H. F., Marks, J. H., … & Wang, D. D. (2025). Adaptive deep brain stimulation timed to gait phase improves walking in Parkinson’s disease. medRxiv.
[4] Azgomi, H. F., Louie, K. H., Bath, J. E., Presbrey, K. N., Balakid, J. P., Marks, J. H., … & Wang, D. D. (2025). Modeling and optimizing deep brain stimulation to enhance gait in Parkinson’s disease: personalized treatment with neurophysiological insights. NPJ Parkinson’s Disease, 11, 173.
[5] Shukla, P. D., Bath, J. E., Louie, K. H., Azgomi, H. F., Patelaki, E., Marks, J., … & Wang, D. D. (2025). Cortico-Pallidal Beta Dynamics Underlie Impaired Turning in Parkinson’s Disease. medRxiv, 2025-11.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/temporally-patterned-deep-brain-stimulation-improves-gait-metrics-and-freezing-of-gait-in-parkinsons-disease/