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- Title
Non-motor outcomes depend on location of neurostimulation in Parkinson's disease.
- Authors
Petry-Schmelzer, Jan Niklas; Krause, Max; Dembek, Till A; Horn, Andreas; Evans, Julian; Ashkan, Keyoumars; Rizos, Alexandra; Silverdale, Monty; Schumacher, Wibke; Sack, Carolin; Loehrer, Philipp A; Fink, Gereon R; Fonoff, Erich T; Martinez-Martin, Pablo; Antonini, Angelo; Barbe, Michael T; Visser-Vandewalle, Veerle; Ray-Chaudhuri, K; Timmermann, Lars; Dafsari, Haidar S
- Abstract
Deep brain stimulation of the subthalamic nucleus is an effective and established therapy for patients with advanced Parkinson's disease improving quality of life, motor symptoms and non-motor symptoms. However, there is a considerable degree of interindividual variability for these outcomes, likely due to variability in electrode placement and stimulation settings. Here, we present probabilistic mapping data from a prospective, open-label, multicentre, international study to investigate the influence of the location of subthalamic nucleus deep brain stimulation on non-motor symptoms in patients with Parkinson's disease. A total of 91 Parkinson's disease patients undergoing bilateral deep brain stimulation of the subthalamic nucleus were included, and we investigated NMSScale, NMSQuestionnaire, Scales for Outcomes in Parkinson's disease-motor examination, -activities of daily living, and -motor complications, and Parkinson's disease Questionnaire-8 preoperatively and at 6-month follow-up after surgery. Leads were localized in standard space using the Lead-DBS toolbox and individual volumes of tissue activated were calculated based on clinical stimulation settings. Probabilistic stimulation maps and non-parametric permutation statistics were applied to identify voxels with significant above or below average improvement for each scale and analysed using the DISTAL atlas. All outcomes improved significantly at follow-up. Significant spatial distribution patterns of neurostimulation were observed for NMSScale total score and its mood/apathy and attention/memory domains. For both domains, voxels associated with below average improvement were mainly located dorsal to the subthalamic nucleus. In contrast, above average improvement for mood/apathy was observed in the ventral border region of the subthalamic nucleus and in its sensorimotor subregion and for attention/memory in the associative subregion. A trend was observed for NMSScale sleep domain showing voxels with above average improvement located ventral to the subthalamic nucleus. Our study provides evidence that the interindividual variability of mood/apathy, attention/memory, and sleep outcomes after subthalamic nucleus deep brain stimulation depends on the location of neurostimulation. This study highlights the importance of holistic assessments of motor and non-motor aspects of Parkinson's disease to tailor surgical targeting and stimulation parameter settings to patients' personal profiles.
- Subjects
PARKINSON'S disease; BRAIN stimulation; DEEP brain stimulation; NEURAL stimulation; SUBTHALAMIC nucleus; BORDERLANDS
- Publication
Brain: A Journal of Neurology, 2019, Vol 142, Issue 11, p3592
- ISSN
0006-8950
- Publication type
journal article
- DOI
10.1093/brain/awz285