A Human Gait Circuit Derived from Brain Lesions and Deep Brain Stimulation

Objectives The human neuroanatomy for gait dysfunction remains unclear. We sought (1) to identify a brain circuit for gait impairment post stroke, (2) to identify a brain circuit for gait changes after subthalamic deep brain stimulation (DBS) for Parkinson's disease (PD), and (3) to test for convergence between these 2 circuits. Methods This cross‐sectional retrospective study used data from 4 independent datasets including 109 individuals with stroke and 125 PD patients who received subthalamic DBS. Gait impairment post‐stroke was measured using the Combined Walking Index. Gait changes after DBS were measured using the gait subscore on the Unified Parkinson Disease Rating Scale part III. Connectivity between lesion locations or DBS sites and 2 a priori locomotor regions (pedunculopontine nucleus and cerebellar locomotor region) was computed using a large normative connectome. We repeated this analysis in a data‐driven fashion to identify additional connections. Results Connectivity between lesion locations and a priori regions were associated with gait impairment post‐stroke ( p < 0.05), along with connectivity to a distributed circuit of other brain regions. Connectivity between DBS sites and our a priori gait regions and connectivity between DBS sites and our lesion‐based gait circuit were all associated with gait changes post DBS ( p < 10 −3 ). Data‐driven gait circuits derived from lesions and DBS showed similar topography and converged on a common brain circuit (spatial r = 0.68, p = 0.0063, 10,000 permutations). Interpretation Lesion locations impairing gait and DBS sites modulating gait converge on a common brain circuit. ANN NEUROL 2026