Meyer Garance M, Sahin Ilkem Aysu, Hollunder Barbara, Butenko Konstantin, Rajamani Nanditha, Neudorfer Clemens, Hart Lauren A, Petry-Schmelzer Jan Niklas, Dafsari Haidar S, Barbe Michael T, Visser-Vandewalle Veerle, Mosley Philip E, Horn Andreas
Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Hum Brain Mapp. 2025 Apr 1;46(5):e70207. doi: 10.1002/hbm.70207.
In Parkinson's Disease (PD), deep brain stimulation of the subthalamic nucleus (STN-DBS) reliably improves motor symptoms, and the circuits mediating these effects have largely been identified. However, non-motor outcomes are more variable, and it remains unclear which specific brain circuits need to be modulated or avoided to improve them. Since numerous non-motor symptoms potentially respond to DBS, it is challenging to independently identify the circuits mediating each one of them. Data compression algorithms such as principal component analysis (PCA) may provide a powerful alternative. This study aimed at providing a proof of concept for this approach by mapping changes along extensive score batteries to a few anatomical fiber bundles and, in turn, estimating changes in individual scores based on stimulation of these tracts. Retrospective data from 56 patients with PD and bilateral STN-DBS was included. The patients had undergone comprehensive clinical assessments covering changes in appetitive behaviors, mood, anxiety, impulsivity, cognition, and empathy. PCA was implemented to identify the main dimensions of neuropsychiatric and neuropsychological outcomes. Using DBS fiber filtering, we identified the structural connections whose stimulation was associated with change along these dimensions. Then, estimates of individual symptom outcomes were derived based on the stimulation of these connections by inverting the PCA. Finally, changes along a specific non-motor score were estimated in an independent validation dataset (N = 68) using the tract model. Four principal components were retained, which could be interpreted to reflect (i) general non-motor improvement; (ii) improvement of mood and cognition and worsening of trait impulsivity; (iii) improvement of cognition; and (iv) improvement of empathy and worsening of impulsive-compulsive behaviors. Each component was associated with the stimulation of spatially segregated fiber bundles connecting regions of the frontal cortex with the subthalamic nucleus. The extent of stimulation of these tracts was able to explain significant amounts of variance in outcomes for individual symptoms in the original cohort (circular analysis), as well as in the rank of depression outcomes in the independent validation cohort. Our approach represents an innovative concept for mapping changes along extensive score batteries to a few anatomical fiber bundles and could pave the way toward personalized deep brain stimulation.
在帕金森病(PD)中,对丘脑底核进行深部脑刺激(STN-DBS)能可靠地改善运动症状,并且介导这些效应的神经回路已基本明确。然而,非运动结果的变化更大,目前尚不清楚需要调节或避免哪些特定脑回路以改善这些结果。由于众多非运动症状可能对DBS有反应,独立识别介导其中每一种症状的神经回路具有挑战性。诸如主成分分析(PCA)等数据压缩算法可能提供一种有力的替代方法。本研究旨在通过将广泛评分量表上的变化映射到少数解剖纤维束,并进而根据对这些纤维束的刺激来估计个体评分的变化,为这种方法提供概念验证。纳入了56例接受双侧STN-DBS治疗的PD患者的回顾性数据。这些患者接受了全面的临床评估,涵盖了食欲行为、情绪、焦虑、冲动性、认知和共情方面的变化。实施PCA以确定神经精神和神经心理结果的主要维度。使用DBS纤维滤波,我们识别出其刺激与这些维度上的变化相关的结构连接。然后,通过对PCA进行反演,基于对这些连接的刺激得出个体症状结果的估计值。最后,在一个独立的验证数据集(N = 68)中使用纤维束模型估计特定非运动评分的变化。保留了四个主成分,可解释为反映(i)总体非运动改善;(ii)情绪和认知改善以及特质冲动性恶化;(iii)认知改善;以及(iv)共情改善和冲动强迫行为恶化。每个成分都与连接额叶皮质和丘脑底核区域的空间分离纤维束的刺激相关。这些纤维束的刺激程度能够解释原始队列中个体症状结果的大量方差(循环分析),以及独立验证队列中抑郁结果的排名。我们的方法代表了一种创新概念,即将广泛评分量表上的变化映射到少数解剖纤维束,并可能为个性化深部脑刺激铺平道路。