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Open Access 25-04-2024 | Parkinson's Disease | Original paper

Clinical and Brain Morphometry Predictors of Deep Brain Stimulation Outcome in Parkinson’s Disease

Authors: Maija Koivu, Aleksi J. Sihvonen, Johanna Eerola-Rautio, K. Amande M. Pauls, Julio Resendiz-Nieves, Nuutti Vartiainen, Riku Kivisaari, Filip Scheperjans, Eero Pekkonen

Published in: Brain Topography

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Abstract

Subthalamic deep brain stimulation (STN-DBS) is known to improve motor function in advanced Parkinson’s disease (PD) and to enable a reduction of anti-parkinsonian medication. While the levodopa challenge test and disease duration are considered good predictors of STN-DBS outcome, other clinical and neuroanatomical predictors are less established. This study aimed to evaluate, in addition to clinical predictors, the effect of patients’ individual brain topography on DBS outcome. The medical records of 35 PD patients were used to analyze DBS outcomes measured with the following scales: Part III of the Unified Parkinson’s Disease Rating Scale (UPDRS-III) off medication at baseline, and at 6-months during medication off and stimulation on, use of anti-parkinsonian medication (LED), Abnormal Involuntary Movement Scale (AIMS) and Non-Motor Symptoms Questionnaire (NMS-Quest). Furthermore, preoperative brain MRI images were utilized to analyze the brain morphology in relation to STN-DBS outcome. With STN-DBS, a 44% reduction in the UPDRS-III score and a 43% decrease in the LED were observed (p<0.001). Dyskinesia and non-motor symptoms decreased significantly [median reductions of 78,6% (IQR 45,5%) and 18,4% (IQR 32,2%) respectively, p=0.001 – 0.047]. Along with the levodopa challenge test, patients’ age correlated with the observed DBS outcome measured as UPDRS-III improvement (ρ= -0.466 – -0.521, p<0.005). Patients with greater LED decline had lower grey matter volumes in left superior medial frontal gyrus, in supplementary motor area and cingulum bilaterally. Additionally, patients with greater UPDRS-III score improvement had lower grey matter volume in similar grey matter areas. These findings remained significant when adjusted for sex, age, baseline LED and UPDRS scores respectively and for total intracranial volume (p=0.0041- 0.001). However, only the LED decrease finding remained significant when the analyses were further controlled for stimulation amplitude. It appears that along with the clinical predictors of STN-DBS outcome, individual patient topographic differences may influence DBS outcome. Clinical Trial Registration Number: NCT06095245, registration date October 23, 2023, retrospectively registered
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Metadata
Title
Clinical and Brain Morphometry Predictors of Deep Brain Stimulation Outcome in Parkinson’s Disease
Authors
Maija Koivu
Aleksi J. Sihvonen
Johanna Eerola-Rautio
K. Amande M. Pauls
Julio Resendiz-Nieves
Nuutti Vartiainen
Riku Kivisaari
Filip Scheperjans
Eero Pekkonen
Publication date
25-04-2024
Publisher
Springer US
Published in
Brain Topography
Print ISSN: 0896-0267
Electronic ISSN: 1573-6792
DOI
https://doi.org/10.1007/s10548-024-01054-2