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Cited by 263Neurological disorders and treatmentsObsessive-Compulsive Spectrum DisordersTranscranial Magnetic Stimulation Studies

Subthalamic deep brain stimulation sweet spots and hyperdirect cortical connectivity in Parkinson’s disease

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Akram, Harith, Sotiropoulos, Stamatios N., Jbabdi, Saad, Georgiev, Dejan, Mahlknecht, Philipp, Hyam, Jonathan, Foltynie, Thomas, Limousin, Patricia +6 more·2017·NeuroImage
DOI 10.1016/j.neuroimage.2017.07.012PMC PMC6581538
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Abstract

Firstly, to identify subthalamic region stimulation clusters that predict maximum improvement in rigidity, bradykinesia and tremor, or emergence of side-effects; and secondly, to map-out the cortical fingerprint, mediated by the hyperdirect pathways which predict maximum efficacy. High angular resolution diffusion imaging in twenty patients with advanced Parkinson's disease was acquired prior to bilateral subthalamic nucleus deep brain stimulation. All contacts were screened one-year from surgery for efficacy and side-effects at different amplitudes. Voxel-based statistical analysis of volumes of tissue activated models was used to identify significant treatment clusters. Probabilistic tractography was employed to identify cortical connectivity patterns associated with treatment efficacy. All patients responded well to treatment (46% mean improvement off medication UPDRS-III [p < 0.0001]) without significant adverse events. Cluster corresponding to maximum improvement in tremor was in the posterior, superior and lateral portion of the nucleus. Clusters corresponding to improvement in bradykinesia and rigidity were nearer the superior border in a further medial and posterior location. The rigidity cluster extended beyond the superior border to the area of the zona incerta and Forel-H2 field. When the clusters where averaged, the coordinates of the area with maximum overall efficacy was X = −10(−9.5), Y = −13(-1) and Z = −7(−3) in MNI(AC-PC) space. Cortical connectivity to primary motor area was predictive of higher improvement in tremor; whilst that to supplementary motor area was predictive of improvement in bradykinesia and rigidity; and connectivity to prefrontal cortex was predictive of improvement in rigidity. These findings support the presence of overlapping stimulation sites within the subthalamic nucleus and its superior border, with different cortical connectivity patterns, associated with maximum improvement in tremor, rigidity and bradykinesia.

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  • In Parkinson's disease, DBS of the subthalamic nucleus linked to the supplementary motor area is associated with improvement in bradykinesia and rigidity, whereas DBS of a nucleus structurally connected to M1 is associated with improvement in tremor.

    “For instance, in Parkinson’s disease, researchers found that DBS on sub-thalamic nucleus linking to the supplementary motor area is associated with improvement in bradykinesia and rigidity, while DBS on nucleus structurally commenting to M1 is associated with improvement in tremor (Akram et al., 2017).”

    From Quantitative mapping of the brain’s structural connectivity using diffusion MRI tractography: A review (2022) · cites this paper as Akram et al., 2017

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Authors
Akram, H., Sotiropoulos, S. N., Jbabdi, S., Georgiev, D., Mahlknecht, P., Hyam, J., Foltynie, T., Limousin, P., De Vita, E., Jahanshahi, M., Hariz, M., Ashburner, J., Behrens, T., & Zrinzo, L.
Affiliations
  • National Hospital for Neurology and Neurosurgery (GB)
  • University of Nottingham (GB)
  • Wellcome Centre for Human Neuroimaging (GB)
Corresponding author
Akram, Harith
ORCID
Venue
NeuroImage
Publisher
Elsevier BV
Published
2017-09
Volume
158
Pages
332-345
ISSN
1053-8119 (ISSN-L)
DOI
10.1016/j.neuroimage.2017.07.012
PMC
PMC6581538
OpenAlex
W2734990562
Cited by
263
References
8
Citations by year
2026: 14 · 2025: 41 · 2024: 28 · 2023: 24 · 2022: 39 · 2021: 38 · 2020: 34 · 2019: 28 · 2018: 16 · 2017: 1
FWCI
15.05
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • NeuroImage (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc-nd)
  • UCL Discovery (University College London) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
Funders
  • Brain Research Trust
  • Wellcome Trust (091593/Z/10/Z)
  • Medical Research Council (MR/L009013/1)
  • EPSRC (EP/L023067/1)
Topics
  • Health Sciences › Medicine › Neurology › Neurological disorders and treatments
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Keywords
Parkinson's disease, subthalamic nucleus, deep brain stimulation, hyperdirect pathway, cortical connectivity, treatment efficacy, stimulation site selection, tremor, rigidity, bradykinesia, supplementary motor area, primary motor cortex, prefrontal cortex, zona incerta
MeSH terms
Brain Mapping, Female, Humans, Image Interpretation, Computer-Assisted, Male, Neural Pathways, Parkinson Disease, Subthalamic Nucleus, Diffusion Magnetic Resonance Imaging, Deep Brain Stimulation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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