Artikel
Outcome of deep brain stimulation of the subthalamic nucleus correlates with electrode location relative to the cortical connectivity pattern delineated by diffusion-based parcellation
Das Outcome der tiefen Hirnstimulation im Nucleus subthalamicus korreliert mit der Elektrodenposition relativ zu der kortikalen Konnektivität aus der diffusionsbasierten Parzellierung
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Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Deep brain stimulation (DBS) is an established method of treatment of the Parkinson disease (PD). However, the optimal location of the DBS electrode within the subthalamic nucleus (STN) is a matter of debate. The aim of this study was to analyze the association between the outcome of the STN-DBS surgery and the electrode position based on diffusion tractography-based parcellation of the STN.
Methods: Retrospective analysis of a group of 20 patients implanted with DBS for PD. Strongest connectivity points inside the STN were estimated using diffusion-based parcellation for three cortical targets – precentral gyrus, supplementary motor area (SMA) and limbic cortex. The distance of the electrode to these strongest connectivity points were compared to outcome parameters, which included levodopa-equivalent-dosis (LED) reduction, reduction of scores of items 32 and 36 from UPDRS-IV and the occurrence of limbic system side effects from the stimulation.
Results: There was a moderate significant correlation between the electrode distance from the strongest connectivity point to the precentral gyrus and the LED reduction (Pearson r=-0.43, P value <0.01) and a weak significant correlation between the electrode distance from the strongest connectivity point to the SMA and the LED reduction (r=-0.327, P value=0.04). The median distance from the strongest connectivity point to the precentral gyrus were significantly lower for patients without limbic system side effects (Mann-Whitney U, P<0.001) and with greater reduction of the UPDRS-IV item 32 score (P=0.02).
Conclusion: The DBS outcome for PD is associated with the position of the electrodes within the STN. Diffusion tractography based analyses, such as diffusion tractography-based parcellation can elucidate the individually variable intrinsic anatomy of the STN and might become useful in DBS trajectory planning.