Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ann Neurol. 2021 Oct;90(4):670-682. doi: 10.1002/ana.26199. Epub 2021 Aug 24.
The subthalamic nucleus (STN) and internal globus pallidus (GPi) are the most effective targets in deep brain stimulation (DBS) for Parkinson's disease (PD). However, the common and specific effects on brain connectivity of stimulating the 2 nuclei remain unclear.
Patients with PD receiving STN-DBS (n = 27, 6 women, mean age 64.8 years) or GPi-DBS (n = 28, 13 women, mean age 64.6 years) were recruited for resting-state functional magnetic resonance imaging to assess the effects of STN-DBS and GPi-DBS on brain functional dynamics.
The functional connectivity both between the somatosensory-motor cortices and thalamus, and between the somatosensory-motor cortices and cerebellum decreased in the DBS-on state compared with the off state (p < 0.05). The changes in thalamocortical connectivity correlated with DBS-induced motor improvement (p < 0.05) and were negatively correlated with the normalized intersection volume of tissues activated at both DBS targets (p < 0.05). STN-DBS modulated functional connectivity among a wider range of brain areas than GPi-DBS (p = 0.009). Notably, only STN-DBS affected connectivity between the postcentral gyrus and cerebellar vermis (p < 0.001) and between the somatomotor and visual networks (p < 0.001).
Our findings highlight common alterations in the motor pathway and its relationship with the motor improvement induced by both STN- and GPi-DBS. The effects on cortico-cerebellar and somatomotor-visual functional connectivity differed between groups, suggesting differentiated neural modulation of the 2 target sites. Our results provide mechanistic insight and yield the potential to refine target selection strategies for focal brain stimulation in PD. ANN NEUROL 2021;90:670-682.
丘脑底核（STN）和内苍白球（GPi）是深部脑刺激（DBS）治疗帕金森病（PD）最有效的靶点。然而，刺激这两个核团对大脑连接的共同和特定影响仍不清楚。
招募了 27 名接受 STN-DBS（6 名女性，平均年龄 64.8 岁）或 28 名接受 GPi-DBS（13 名女性，平均年龄 64.6 岁）的 PD 患者，进行静息态功能磁共振成像，以评估 STN-DBS 和 GPi-DBS 对大脑功能动力学的影响。
与 DBS 关闭状态相比，DBS 开启状态下感觉运动皮质与丘脑之间以及感觉运动皮质与小脑之间的功能连接均降低（p<0.05）。丘脑皮质连接的变化与 DBS 诱导的运动改善相关（p<0.05），与两个 DBS 靶点激活的组织归一化交叉体积呈负相关（p<0.05）。与 GPi-DBS 相比，STN-DBS 调节了更广泛的大脑区域之间的功能连接（p=0.009）。值得注意的是，只有 STN-DBS 影响了中央后回与小脑蚓部之间（p<0.001）和躯体运动与视觉网络之间（p<0.001）的连接。
我们的研究结果突出了两种 DBS 方式共同引起的运动通路及其与运动改善之间的共同改变。皮质小脑和躯体运动-视觉功能连接的影响在两组之间不同，表明两个目标部位的神经调节存在差异。我们的研究结果提供了对机制的深入了解，并有可能为 PD 的局灶性脑刺激的靶点选择策略提供参考。
