title: Effects of DBS in parkinsonian patients depend on the structural integrity of frontal cortex.
abstract: While deep brain stimulation of the subthalamic nucleus (STN-DBS) has evolved to an evidence-based standard treatment for Parkinson's disease (PD), the targeted cerebral networks are poorly described and no objective predictors for the postoperative clinical response exist. To elucidate the systemic mechanisms of DBS, we analysed cerebral grey matter properties using cortical thickness measurements and addressed the dependence of structural integrity on clinical outcome. Thirty one patients with idiopathic PD without dementia (23 males, age: 63.4 ± 9.3, Hoehn and Yahr: 3.5 ± 0.8) were selected for DBS treatment. The patients underwent whole-brain preoperative T1 MR-Imaging at 3 T. Grey matter integrity was assessed by cortical thickness measurements with FreeSurfer. The clinical motor outcome markedly improved after STN-DBS in comparison to the preoperative condition. The cortical thickness of the frontal lobe (paracentral area and superior frontal region) predicted the clinical improvement after STN-DBS. Moreover, in patients with cortical atrophy of these areas a higher stimulation voltage was needed for an optimal clinical response. Our data suggest that the effects of STN-DBS in PD directly depend on frontal lobe grey matter integrity. Cortical atrophy of this region might represent a distinct predictor of a poor motor outcome after STN-DBS in PD patients.
authors.affiliation: Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Muthuraman
authors.initials: M
authors.lastname: Muthuraman
authors.affiliation: Department of Neurology, Christian Albrechts University, Kiel, Germany.
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
authors.affiliation: Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Nabin
authors.initials: N
authors.lastname: Koirala
authors.affiliation: Department of Neuroradiology, Christian Albrechts University, Kiel, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Riedel
authors.affiliation: Department of Neurology, Julius Maximilians University, Würzburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Volkmann
authors.affiliation: Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Sergiu
authors.initials: S
authors.lastname: Groppa
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods; D005260:Female; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D020531:Subthalamic Nucleus; D016896:Treatment Outcome; D057188:Workflow