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Subthalamic deep brain stimulation sweet spots and hyperdirect cortical connectivity in Parkinson's disease
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2017 (English)In: NeuroImage, ISSN 1053-8119, E-ISSN 1095-9572, Vol. 158, p. 332-345Article in journal (Refereed) Published
Abstract [en]

Objectives: Firstly, to identify subthalamic region stimulation clusters that predict maximum improvement in rigidity, bradykinesia and tremor, or emergence of side-effects; and secondly, to map-out the cortical fingerprint, mediated by the hyperdirect pathways which predict maximum efficacy.

Methods: High angular resolution diffusion imaging in twenty patients with advanced Parkinson's disease was acquired prior to bilateral subthalamic nucleus deep brain stimulation. All contacts were screened one-year from surgery for efficacy and side-effects at different amplitudes. Voxel-based statistical analysis of volumes of tissue activated models was used to identify significant treatment clusters. Probabilistic tractography was employed to identify cortical connectivity patterns associated with treatment efficacy.

Results: All patients responded well to treatment (46% mean improvement off medication UPDRS-III [p < 0.0001]) without significant adverse events. Cluster corresponding to maximum improvement in tremor was in the posterior, superior and lateral portion of the nucleus. Clusters corresponding to improvement in bradykinesia and rigidity were nearer the superior border in a further medial and posterior location. The rigidity cluster extended beyond the superior border to the area of the zona incerta and Forel-H-2 field. When the clusters where averaged, the coordinates of the area with maximum overall efficacy was X = -10(-9.5), Y = -3(-1) and Z = -7(-3) in MNI(AC-PC) space. Cortical connectivity to primary motor area was predictive of higher improvement in tremor; whilst that to supplementary motor area was predictive of improvement in bradykinesia and rigidity; and connectivity to prefrontal cortex was predictive of improvement in rigidity.

Interpretation: These findings support the presence of overlapping stimulation sites within the subthalamic nucleus and its superior border, with different cortical connectivity patterns, associated with maximum improvement in tremor, rigidity and bradykinesia.

Place, publisher, year, edition, pages
Elsevier, 2017. Vol. 158, p. 332-345
Keywords [en]
Diffusion weighted imaging (DWI), Connectivity, Parkinson's disease (PD), Subthalamic nucleus (STN), Volume of tissue activated (VTA), Hyperdirect pathway
National Category
Neurology
Identifiers
URN: urn:nbn:se:umu:diva-140657DOI: 10.1016/j.neuroimage.2017.07.012ISI: 000411450600030PubMedID: 28711737OAI: oai:DiVA.org:umu-140657DiVA, id: diva2:1149586
Available from: 2017-10-16 Created: 2017-10-16 Last updated: 2018-06-09Bibliographically approved

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De Vita, EnricoHariz, Marwan

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