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Subthalamic and pallidal deep brain stimulation: are we modulating the same network?

Leon Sobesky1, Lukas Goede1, Vincent J J Odekerken2

  • 1Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Neurology, 10117 Berlin, Germany.

Brain : a Journal of Neurology
|August 28, 2021
PubMed
Summary
This summary is machine-generated.

Deep brain stimulation for Parkinson's disease may work through a common network, regardless of whether the subthalamic nucleus or internal pallidum is targeted. Connectivity maps showed similar effective regions, supporting a shared functional network for treatment benefits.

Keywords:
Parkinson’s diseaseconnectivitydeep brain stimulationinternal globus pallidus/GPisubthalamic nucleus/STN

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Area of Science:

  • Neuroscience
  • Neurology
  • Medical Imaging

Background:

  • Deep brain stimulation (DBS) is a key treatment for Parkinson's disease (PD).
  • The subthalamic nucleus (STN) and internal globus pallidus (GPi) are primary DBS targets.
  • Optimal target selection between STN and GPi remains debated, potentially due to overlapping functional networks.

Purpose of the Study:

  • To investigate if effective DBS in PD relies on a common functional network, irrespective of the specific target (STN or GPi).
  • To compare connectivity profiles associated with clinical improvement for STN-DBS and GPi-DBS.
  • To determine if a shared network map can predict treatment outcomes across both target groups.

Main Methods:

  • Connectivity profiles were derived from DBS electrode locations in 94 STN-DBS and 28 GPi-DBS PD patients.
  • A normative connectome atlas based on 1000 healthy subjects was used.
  • Connectivity maps linked to clinical improvement were calculated for each cohort and compared. An agreement map of common regions was also generated.

Main Results:

  • Connectivity profiles associated with optimal outcomes showed striking similarity between STN-DBS and GPi-DBS cohorts.
  • These profiles demonstrated cross-predictive utility for clinical improvement in the respective other cohort (R = 0.37, P < 0.001; R = 0.34, P = 0.032).
  • An agreement map of common regions explained additional variance in clinical outcomes compared to cohort-specific maps.

Conclusions:

  • Effective DBS for Parkinson's disease likely engages a largely overlapping functional network, regardless of whether the STN or GPi is the stimulation target.
  • This shared network hypothesis provides a potential explanation for the comparable efficacy observed between STN and GPi DBS.
  • Further research using indirect connectivity metrics supports the concept of a unified network underpinning DBS benefits in PD motor symptoms.