Dataset Information

Brain connectivity markers for the identification of effective contacts in subthalamic nucleus deep brain stimulation.

ABSTRACT: The clinical benefit of deep brain stimulation (DBS) for Parkinson's disease (PD) is relevant to the tracts adjacent to the stimulation site, but it remains unclear what connectivity pattern is associated with effective DBS. The aim of this study was to identify clinically effective electrode contacts on the basis of brain connectivity markers derived from diffusion tensor tractography. We reviewed 77 PD patients who underwent bilateral subthalamic nucleus DBS surgery. The patients were assigned into the training (n = 58) and validation (n = 19) groups. According to the therapeutic window size, all contacts were classified into effective and ineffective groups. The whole-brain connectivity of each contact's volume of tissue activated was estimated using tractography with preoperative diffusion tensor data. Extracted connectivity features were put into an all-relevant feature selection procedure within cross-validation loops, to identify features with significant discriminative power for contact classification. A total of 616 contacts on 154 DBS leads were discriminated, with 388 and 228 contacts being classified as effective and ineffective ones, respectively. After the feature selection, the connectivity of contacts with the thalamus, pallidum, hippocampus, primary motor area, supplementary motor area and superior frontal gyrus was identified to significantly contribute to contact classification. Based on these relevant features, the random forest model constructed from the training group achieved an accuracy of 84.9% in the validation group, to discriminate effective contacts from the ineffective. Our findings advanced the understanding of the specific brain connectivity patterns associated with clinical effective electrode contacts, which potentially guided postoperative DBS programming.

SUBMITTER: Lin H

PROVIDER: S-EPMC7268081 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Brain connectivity markers for the identification of effective contacts in subthalamic nucleus deep brain stimulation.

Lin Hai H Na Peng P Zhang Doudou D Liu Jiali J Cai Xiaodong X Li Weiping W

Human brain mapping 20200117 8

The clinical benefit of deep brain stimulation (DBS) for Parkinson's disease (PD) is relevant to the tracts adjacent to the stimulation site, but it remains unclear what connectivity pattern is associated with effective DBS. The aim of this study was to identify clinically effective electrode contacts on the basis of brain connectivity markers derived from diffusion tensor tractography. We reviewed 77 PD patients who underwent bilateral subthalamic nucleus DBS surgery. The patients were assigned ...[more]

PMID: 31951307

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Project description:Deep brain stimulation therapy is an effective symptomatic treatment for Parkinson's disease, yet the precise mechanisms responsible for its therapeutic effects remain unclear. Although the targets of deep brain stimulation are grey matter structures, axonal modulation is known to play an important role in deep brain stimulation's therapeutic mechanism. Several white matter structures in proximity to the subthalamic nucleus have been implicated in the clinical benefits of deep brain stimulation for Parkinson's disease. We assessed the connectivity patterns that characterize clinically beneficial electrodes in Parkinson's disease patients, after deep brain stimulation of the subthalamic nucleus. We evaluated 22 patients with Parkinson's disease (11 females, age 57 ± 9.1 years, disease duration 13.3 ± 6.3 years) who received bilateral deep brain stimulation of the subthalamic nucleus at the National Institutes of Health. During an initial electrode screening session, one month after deep brain stimulation implantation, the clinical benefits of each contact were determined. The electrode was localized by coregistering preoperative magnetic resonance imaging and postoperative computer tomography images and the volume of tissue activated was estimated from stimulation voltage and impedance. Brain connectivity for the volume of tissue activated of deep brain stimulation contacts was assessed using probabilistic tractography with diffusion-tensor data. Areas most frequently connected to clinically effective contacts included the thalamus, substantia nigra, brainstem and superior frontal gyrus. A series of discriminant analyses demonstrated that the strength of connectivity to the superior frontal gyrus and the thalamus were positively associated with clinical effectiveness. The connectivity patterns observed in our study suggest that the modulation of white matter tracts directed to the superior frontal gyrus and the thalamus is associated with favourable clinical outcomes and may contribute to the therapeutic effects of deep brain stimulation. Our method can be further developed to reliably identify effective deep brain stimulation contacts and aid in the programming process.

Project description:ObjectiveCurrent understanding of the neuromodulatory effects of deep brain stimulation (DBS) on large-scale brain networks remains elusive, largely due to the lack of techniques that can reveal DBS-induced activity at the whole-brain level. Using a novel 3T magnetic resonance imaging (MRI)-compatible stimulator, we investigated whole-brain effects of subthalamic nucleus (STN) stimulation in patients with Parkinson disease.MethodsFourteen patients received STN-DBS treatment and participated in a block-design functional MRI (fMRI) experiment, wherein stimulations were delivered during "ON" blocks interleaved with "OFF" blocks. fMRI responses to low-frequency (60Hz) and high-frequency(130Hz) STN-DBS were measured 1, 3, 6, and 12 months postsurgery. To ensure reliability, multiple runs (48 minutes) of fMRI data were acquired at each postsurgical visit. Presurgical resting-state fMRI (30 minutes) data were also acquired.ResultsTwo neurocircuits showed highly replicable, but distinct responses to STN-DBS. A circuit involving the globus pallidus internus (GPi), thalamus, and deep cerebellar nuclei was significantly activated, whereas another circuit involving the primary motor cortex (M1), putamen, and cerebellum showed DBS-induced deactivation. These 2 circuits were dissociable in terms of their DBS-induced responses and resting-state functional connectivity. The GPi circuit was frequency-dependent, selectively responding to high-frequency stimulation, whereas the M1 circuit was responsive in a time-dependent manner, showing enhanced deactivation over time. Finally, activation of the GPi circuit was associated with overall motor improvement, whereas M1 circuit deactivation was related to reduced bradykinesia.InterpretationConcurrent DBS-fMRI using 3T revealed 2 distinct circuits that responded differentially to STN-DBS and were related to divergent symptoms, a finding that may provide novel insights into the neural mechanisms underlying DBS. ANN NEUROL 2020;88:1178-1193.

Dataset Information

Brain connectivity markers for the identification of effective contacts in subthalamic nucleus deep brain stimulation.

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Brain connectivity markers for the identification of effective contacts in subthalamic nucleus deep brain stimulation.

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