To identify imaging biomarkers for predicting motor outcomes in Parkinson’s disease (PD) patients following bilateral subthalamic nucleus deep brain stimulation (STN-DBS) using postoperative resting-state functional MRI (rs-fMRI).

STN-DBS effectively alleviates motor fluctuations in advanced PD. Most predictive studies focus on pre-surgical imaging, yet stimulation-related motor improvement depends on both baseline and surgical factors. This study investigated whether rs-fMRI connectivity obtained during initial DBS programming predicts motor improvement six months post-surgery.

PD patients who underwent bilateral STN-DBS at Taichung Veterans General Hospital (Oct 2018–Jun 2024) underwent rs-fMRI with a Siemens 1.5 T scanner during initial parameter programming. Age- and sex-matched healthy controls (Aug 2024–Jul 2025) were scanned using the same protocol. Seed-based connectivity analysis (CONN 20.b) compared PD-DBS patients and controls, and examined correlations between connectivity patterns and stimulation-related changes in Movement Disorder Society–Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III scores in the off-medication state six months after surgery.

Thirty-nine PD patients and 20 healthy controls were included. Compared with controls, PD-DBS patients exhibited decreased connectivity between the right angular gyrus (AG) and left inferior lateral occipital cortex (LOC), left AG and left superior LOC, left occipital fusiform gyrus and left lingual gyrus, and right supracalcarine cortex and left postcentral gyrus. Increased connectivity was observed between the right cerebellum and right frontal pole. Connectivity strength in these networks significantly correlated with stimulation-related motor improvement.

Post-DBS rs-fMRI connectivity alterations are associated with motor outcomes and may serve as imaging biomarkers for predicting clinical response to STN-DBS in future large-scale studies.