Till A Dembek1,2, Jan Roediger1, Andreas Horn3, Paul Reker1, Carina Oehrn4, Haidar S Dafsari1, Ningfei Li3, Andrea A Kühn3, Gereon R Fink1,4, Veerle Visser-Vandewalle2, Michael T Barbe1, Lars Timmermann5. 1. Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany. 2. Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University of Cologne, Cologne, Germany. 3. Movement Disorders and Neuromodulation Unit, Department for Neurology, Charité-University Medicine Berlin, Berlin, Germany. 4. Cognitive Neuroscience, Institute of Neuroscience and Medicine, Jülich Research Center, Jülich, Germany. 5. Department of Neurology, University Hospital of Marburg and Gießen, Marburg, Germany.
Abstract
OBJECTIVE: To investigate whether functional sweet spots of deep brain stimulation (DBS) in the subthalamic nucleus (STN) can predict motor improvement in Parkinson disease (PD) patients. METHODS: Stimulation effects of 449 DBS settings in 21 PD patients were clinically and quantitatively assessed through standardized monopolar reviews and mapped into standard space. A sweet spot for best motor outcome was determined using voxelwise and nonparametric permutation statistics. Two independent cohorts were used to investigate whether stimulation overlap with the sweet spot could predict acute motor outcome (10 patients, 163 settings) and long-term overall Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) improvement (63 patients). RESULTS: Significant clusters for suppression of rigidity and akinesia, as well as for overall motor improvement, resided around the dorsolateral border of the STN. Overlap of the volume of tissue activated with the sweet spot for overall motor improvement explained R2 = 37% of the variance in acute motor improvement, more than triple what was explained by overlap with the STN (R2 = 9%) and its sensorimotor subpart (R2 = 10%). In the second independent cohort, sweet spot overlap explained R2 = 20% of the variance in long-term UPDRS-III improvement, which was equivalent to the variance explained by overlap with the STN (R2 = 21%) and sensorimotor STN (R2 = 19%). INTERPRETATION: This study is the first to predict clinical improvement of parkinsonian motor symptoms across cohorts based on local DBS effects only. The new approach revealed a distinct sweet spot for STN DBS in PD. Stimulation overlap with the sweet spot can predict short- and long-term motor outcome and may be used to guide DBS programming. ANN NEUROL 2019;86:527-538.
OBJECTIVE: To investigate whether functional sweet spots of deep brain stimulation (DBS) in the subthalamic nucleus (STN) can predict motor improvement in Parkinson disease (PD) patients. METHODS: Stimulation effects of 449 DBS settings in 21 PDpatients were clinically and quantitatively assessed through standardized monopolar reviews and mapped into standard space. A sweet spot for best motor outcome was determined using voxelwise and nonparametric permutation statistics. Two independent cohorts were used to investigate whether stimulation overlap with the sweet spot could predict acute motor outcome (10 patients, 163 settings) and long-term overall Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) improvement (63 patients). RESULTS: Significant clusters for suppression of rigidity and akinesia, as well as for overall motor improvement, resided around the dorsolateral border of the STN. Overlap of the volume of tissue activated with the sweet spot for overall motor improvement explained R2 = 37% of the variance in acute motor improvement, more than triple what was explained by overlap with the STN (R2 = 9%) and its sensorimotor subpart (R2 = 10%). In the second independent cohort, sweet spot overlap explained R2 = 20% of the variance in long-term UPDRS-III improvement, which was equivalent to the variance explained by overlap with the STN (R2 = 21%) and sensorimotor STN (R2 = 19%). INTERPRETATION: This study is the first to predict clinical improvement of parkinsonian motor symptoms across cohorts based on local DBS effects only. The new approach revealed a distinct sweet spot for STN DBS in PD. Stimulation overlap with the sweet spot can predict short- and long-term motor outcome and may be used to guide DBS programming. ANN NEUROL 2019;86:527-538.
Authors: Yasmine M Kehnemouyi; Kevin B Wilkins; Chioma M Anidi; Ross W Anderson; Muhammad Furqan Afzal; Helen M Bronte-Stewart Journal: Brain Date: 2021-03-03 Impact factor: 15.255
Authors: Angela M Noecker; Anneke M Frankemolle-Gilbert; Bryan Howell; Mikkel V Petersen; Sinem Balta Beylergil; Aasef G Shaikh; Cameron C McIntyre Journal: Neuromodulation Date: 2021-01-03
Authors: Joachim K Krauss; Nir Lipsman; Tipu Aziz; Alexandre Boutet; Peter Brown; Jin Woo Chang; Benjamin Davidson; Warren M Grill; Marwan I Hariz; Andreas Horn; Michael Schulder; Antonios Mammis; Peter A Tass; Jens Volkmann; Andres M Lozano Journal: Nat Rev Neurol Date: 2020-11-26 Impact factor: 42.937
Authors: Miranda J Munoz; Lisa C Goelz; Gian D Pal; Jessica A Karl; Leo Verhagen Metman; Sepehr Sani; Joshua M Rosenow; Jody D Ciolino; Ajay S Kurani; Daniel M Corcos; Fabian J David Journal: Neuromodulation Date: 2022-06-14
Authors: Gordon Duffley; Barbara J Lutz; Aniko Szabo; Adrienne Wright; Christopher W Hess; Adolfo Ramirez-Zamora; Pamela Zeilman; Shannon Chiu; Kelly D Foote; Michael S Okun; Christopher R Butson Journal: JAMA Neurol Date: 2021-08-01 Impact factor: 29.907
Authors: Haidar S Dafsari; K Ray-Chaudhuri; Keyoumars Ashkan; Lena Sachse; Picabo Mahlstedt; Monty Silverdale; Alexandra Rizos; Marian Strack; Stefanie T Jost; Paul Reker; Michael Samuel; Veerle Visser-Vandewalle; Julian Evans; Angelo Antonini; Pablo Martinez-Martin; Lars Timmermann Journal: J Neurol Date: 2020-03-09 Impact factor: 4.849