title: Motor and Nonmotor Circuitry Activation Induced by Subthalamic Nucleus Deep Brain Stimulation in Patients With Parkinson Disease: Intraoperative Functional Magnetic Resonance Imaging for Deep Brain Stimulation.
abstract: OBJECTIVE
  To test the hypothesis suggested by previous studies that subthalamic nucleus (STN) deep brain stimulation (DBS) in patients with Parkinson disease would affect the activity of motor and nonmotor networks, we applied intraoperative functional magnetic resonance imaging (fMRI) to patients receiving DBS.
  
  
  METHODS
  Ten patients receiving STN DBS for Parkinson disease underwent intraoperative 1.5-T fMRI during high-frequency stimulation delivered via an external pulse generator. The study was conducted between January 1, 2013, and September 30, 2014.
  
  
  RESULTS
  We observed blood oxygen level-dependent (BOLD) signal changes (false discovery rate <0.001) in the motor circuitry (including the primary motor, premotor, and supplementary motor cortices; thalamus; pedunculopontine nucleus; and cerebellum) and in the limbic circuitry (including the cingulate and insular cortices). Activation of the motor network was observed also after applying a Bonferroni correction (P<.001) to the data set, suggesting that across patients, BOLD changes in the motor circuitry are more consistent compared with those occurring in the nonmotor network.
  
  
  CONCLUSIONS
  These findings support the modulatory role of STN DBS on the activity of motor and nonmotor networks and suggest complex mechanisms as the basis of the efficacy of this treatment modality. Furthermore, these results suggest that across patients, BOLD changes in the motor circuitry are more consistent than those in the nonmotor network. With further studies combining the use of real-time intraoperative fMRI with clinical outcomes in patients treated with DBS, functional imaging techniques have the potential not only to elucidate the mechanisms of DBS functioning but also to guide and assist in the surgical treatment of patients affected by movement and neuropsychiatric disorders.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01809613.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Knight
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Paola
authors.initials: P
authors.lastname: Testini
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN.
authors.forename: Hoon-Ki
authors.initials: HK
authors.lastname: Min
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
authors.forename: William S
authors.initials: WS
authors.lastname: Gibson
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN.
authors.forename: Krzysztof R
authors.initials: KR
authors.lastname: Gorny
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Favazza
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN.
authors.forename: Joel P
authors.initials: JP
authors.lastname: Felmlee
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Inyong
authors.initials: I
authors.lastname: Kim
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN.
authors.forename: Kirk M
authors.initials: KM
authors.lastname: Welker
authors.affiliation: Department of Neurosurgery, Swedish Medical Center, Seattle, WA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Clayton
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Klassen
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN. Electronic address: chang.suyoune@mayo.edu.
authors.forename: Su-youne
authors.initials: SY
authors.lastname: Chang
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN. Electronic address: lee.kendall@mayo.edu.
authors.forename: Kendall H
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D065726:Limbic Lobe / Q000473:pathology / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009043:Motor Activity / Q000502:physiology*; D009044:Motor Cortex / Q000473:pathology / Q000503:physiopathology*; D010300:Parkinson Disease / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D020531:Subthalamic Nucleus