Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy.
Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy.
J Parkinsons Dis. 2023;13(5):797-809. doi: 10.3233/JPD-230005.
The hypothesis that the effectiveness of deep brain stimulation (DBS) in Parkinson's disease (PD) would be related to connectivity dysfunctions between the site of stimulation and other brain regions is growing.
To investigate how the subthalamic nucleus (STN), the most frequently used DBS target for PD, is functionally linked to other brain regions in PD patients according to DBS eligibility.
Clinical data and resting-state functional MRI were acquired from 60 PD patients and 60 age- and sex-matched healthy subjects within an ongoing longitudinal project. PD patients were divided into 19 patients eligible for DBS and 41 non-candidates. Bilateral STN were selected as regions of interest and a seed-based functional MRI connectivity analysis was performed.
A decreased functional connectivity between STN and sensorimotor cortex in both PD patient groups compared to controls was found. Whereas an increased functional connectivity between STN and thalamus was found in PD patient groups relative to controls. Candidates for DBS showed a decreased functional connectivity between bilateral STN and bilateral sensorimotor areas relative to non-candidates. In patients eligible for DBS, a weaker STN functional connectivity with left supramarginal and angular gyri was related with a more severe rigidity and bradykinesia whereas a higher connectivity between STN and cerebellum/pons was related to poorer tremor score.
Our results suggest that functional connectivity of STN varies among PD patients eligible or not for DBS. Future studies would confirm whether DBS modulates and restores functional connectivity between STN and sensorimotor areas in treated patients.
深部脑刺激（DBS）在帕金森病（PD）中的有效性与刺激部位和其他脑区之间的连通功能障碍有关，这一假说正在得到越来越多的认同。
根据 DBS 的适应证，研究 PD 患者的丘脑底核（STN），即最常用于 PD 的 DBS 靶点，与其他脑区之间的功能联系。
在一项正在进行的纵向研究中，从 60 名 PD 患者和 60 名年龄和性别匹配的健康对照者中获取临床数据和静息态功能磁共振成像（rs-fMRI）。将 PD 患者分为 19 名适合 DBS 的患者和 41 名非候选者。双侧 STN 被选为感兴趣区，并进行基于种子的功能磁共振连接分析。
与对照组相比，两组 PD 患者的双侧 STN 与感觉运动皮层之间的功能连接均降低。而 PD 患者组相对于对照组，双侧 STN 与丘脑之间的功能连接增加。与非候选者相比，适合 DBS 的患者双侧 STN 与双侧感觉运动区之间的功能连接降低。在适合 DBS 的患者中，左侧缘上回和角回的 STN 功能连接较弱与更严重的僵硬和运动迟缓有关，而 STN 与小脑/脑桥之间的连接较强与震颤评分较差有关。
我们的研究结果表明，适合或不适合 DBS 的 PD 患者的 STN 功能连接存在差异。未来的研究将证实 DBS 是否可以调节和恢复治疗患者的 STN 与感觉运动区之间的功能连接。
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