A positive correlation between fractional white matter volume and the response of Parkinson disease patients to subthalamic stimulation.
BACKGROUND
Since optimal patient selection is essential for the success of subthalamic nucleus (STN) stimulation, the identification of reliable outcome predictors is important. The purpose of this study was to identify new imaging characteristics sufficiently reliable to predict treatment results.


METHODS
Using preoperative magnetic resonance imaging studies of 21 Parkinson disease (PD) patients treated by STN stimulation, we performed whole brain-based analysis of voxel-based morphometry (VBM) data. Intracranial structures segmented into the gray matter fraction (GMF), white matter fraction (WMF), and cerebrospinal fluid fraction (CSFF) were subjected to univariate and multivariate analysis of the correlation between fractional volumes and postoperative improvement rates using the Unified PD Rating Scale (UPDRS).


RESULTS
At 3 months after surgery, the WMF was significantly correlated with improvement rated on the total UPDRS (p = 0.006), UPDRS part II (activities of daily living; p = 0.008), UPDRS part III (motor; p = 0.005). In contrast, there was no significant correlation between the effect of STN stimulation and GMF or the effect of stimulation and CSFF. The WMF also showed a significant correlation with postoperative scores in the "on" drug and "on" stimulation state (total UPDRS, p = 0.027; UPDRS part II, p = 0.019; UPDRS part III, p = 0.034).


CONCLUSIONS
Our data indicate that patients with a larger white matter volume benefited from STN stimulation whereas the volume of other brain structures was not correlated with its effect. We posit that preserved connectivity between components of the basal ganglia-thalamocortical circuit may be required for the effectiveness of electrical stimulation. VBM may represent a powerful tool to predict the response of patients with advanced PD to STN stimulation.
Hamasaki
Tadashi
T
Department of Neurosurgery, Kumamoto University Medical School, 1-1-1 Honjo, Kumamoto 860-8556, Japan. thamasaki-nsu@umin.ac.jp
Yamada
Kazumichi
K
Hirai
Toshinori
T
Kuratsu
Jun-ichi
J
D000203:Activities of Daily Living / Q000145:classification; D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage; D001921:Brain / Q000473:pathology*; D046690:Deep Brain Stimulation; D004292:Dominance, Cerebral / Q000502:physiology; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007980:Levodopa / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D009460:Neurologic Examination; D038361:Neuronavigation; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D018579:Patient Selection; D011379:Prognosis; D012984:Software; D013223:Statistics as Topic; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa