Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China.
MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China.
Mov Disord. 2024 Aug;39(8):1352-1363. doi: 10.1002/mds.29874. Epub 2024 Jun 18.
Patients with Parkinson's disease (PD) respond to deep brain stimulation (DBS) variably. However, how brain substrates restrict DBS outcomes remains unclear.
In this article, we aim to identify prognostic brain signatures for explaining the response variability.
We retrospectively investigated a cohort of patients with PD (n = 141) between 2017 and 2022, and defined DBS outcomes as the improvement ratio of clinical motor scores. We used a deviation index to quantify individual perturbations on a reference structural covariance network acquired with preoperative T1-weighted magnetic resonance imaging. The neurobiological perturbations of patients were represented as z scored indices based on the chronological perturbations measured on a group of normal aging adults.
After applying stringent statistical tests (z > 2.5) and correcting for false discoveries (P < 0.01), we found that accelerated deviations mainly affected the prefrontal cortex, motor strip, limbic system, and cerebellum in PD. Particularly, a negative network within the accelerated deviations, expressed as "more preoperative deviations, less postoperative improvements," could predict DBS outcomes (mean absolute error = 0.09, R = 0.15). Moreover, a fusion of personal brain predictors and medical responses significantly improved traditional evaluations of DBS outcomes. Notably, the most important brain predictor, a pathway connecting the cognitive unit (prefrontal cortex) and motor control unit (cerebellum and motor strip), partially mediates DBS outcomes with the age at surgery.
Our findings suggest that individual structural perturbations on the cognitive motor control circuit are critical for modulating DBS outcomes. Interventions toward the circuit have the potential for additional clinical improvements. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
帕金森病（PD）患者对深部脑刺激（DBS）的反应各不相同。然而，大脑基质如何限制 DBS 结果尚不清楚。
本文旨在确定预测大脑特征，以解释反应的可变性。
我们回顾性调查了 2017 年至 2022 年间的 141 例 PD 患者队列，并将临床运动评分的改善率定义为 DBS 结果。我们使用偏差指数来量化个体对术前 T1 加权磁共振成像获得的参考结构协变网络的干扰。患者的神经生物学干扰通过基于正常老化成年人测量的时间干扰的 z 得分指数来表示。
在应用严格的统计检验（z > 2.5）和校正假发现（P < 0.01）后，我们发现加速偏差主要影响 PD 患者的前额叶皮层、运动带、边缘系统和小脑。特别是，加速偏差中的一个负网络，表现为“术前偏差越大，术后改善越小”，可以预测 DBS 结果（平均绝对误差= 0.09，R = 0.15）。此外，个人大脑预测因子和医疗反应的融合显著改善了 DBS 结果的传统评估。值得注意的是，最重要的大脑预测因子，连接认知单元（前额叶皮层）和运动控制单元（小脑和运动带）的通路，部分介导了 DBS 结果与手术时的年龄。
我们的研究结果表明，认知运动控制回路中个体结构的干扰对于调节 DBS 结果至关重要。针对该回路的干预措施有可能进一步改善临床结果。
