Deep brain stimulation of symptom-specific networks in Parkinson's disease

Nanditha Rajamani; Helen Friedrich; Konstantin Butenko; Till Dembek; Florian Lange; Pavel Navrátil; Patricia Zvarova; Barbara Hollunder; Rob M A de Bie; Vincent J J Odekerken; Jens Volkmann; Xin Xu; Zhipei Ling; Chen Yao; Petra Ritter; Wolf-Julian Neumann; Georgios P Skandalakis; Spyridon Komaitis; Aristotelis Kalyvas; Christos Koutsarnakis; George Stranjalis; Michael Barbe; Vanessa Milanese; Michael D Fox; Andrea A Kühn; Erik Middlebrooks; Ningfei Li; Martin Reich; Clemens Neudorfer; Andreas Horn

doi:10.1038/s41467-024-48731-1

Deep brain stimulation of symptom-specific networks in Parkinson's disease

Nat Commun. 2024 May 31;15(1):4662. doi: 10.1038/s41467-024-48731-1.

Authors

Nanditha Rajamani¹, Helen Friedrich^{2

3}, Konstantin Butenko², Till Dembek^{2

4}, Florian Lange⁵, Pavel Navrátil⁵, Patricia Zvarova^{6

7}, Barbara Hollunder^{6

7

8}, Rob M A de Bie⁹, Vincent J J Odekerken⁹, Jens Volkmann⁵, Xin Xu¹⁰, Zhipei Ling¹¹, Chen Yao¹², Petra Ritter^{6

7

8

13}, Wolf-Julian Neumann⁶, Georgios P Skandalakis^{14

15}, Spyridon Komaitis^{15

16}, Aristotelis Kalyvas^{15

17}, Christos Koutsarnakis¹⁵, George Stranjalis¹⁵, Michael Barbe⁴, Vanessa Milanese^{18

19

20}, Michael D Fox^{2

21

22}, Andrea A Kühn^{6

7

8}, Erik Middlebrooks²³, Ningfei Li⁶, Martin Reich⁵, Clemens Neudorfer^{6

2

21

22}, Andreas Horn^{6

2

21

22}

Affiliations

¹ Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany. [email protected].
² Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
³ University of Würzburg, Faculty of Medicine, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.
⁴ Department of Neurology, University of Cologne, Cologne, Germany.
⁵ Department of Neurology, University Clinic of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
⁶ Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
⁷ Einstein Center Digital Future, Berlin, 10117, Germany.
⁸ Brain Simulation Section, Department of Neurology, Charité University Medicine Berlin and Berlin Institute of Health, Berlin, 10117, Germany.
⁹ Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
¹⁰ Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100853, China.
¹¹ Department of Neurosurgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, 572000, China.
¹² Department of Neurosurgery, The National Key Clinic Specialty, Shenzhen Key Laboratory of Neurosurgery, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, China.
¹³ Bernstein center for Computational Neuroscience Berlin, Berlin, 10117, Germany.
¹⁴ Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03756, USA.
¹⁵ Department of Neurosurgery, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital, Athens, Greece.
¹⁶ Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁷ Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
¹⁸ Neurosurgical Division, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
¹⁹ Department of Neurosurgery, Mayo Clinic, Florida, USA.
²⁰ Movement Disorders and Neuromodulation Unit, DOMMO Clinic, São Paulo, Brazil.
²¹ Harvard Medical School, Boston, MA, 02114, USA.
²² Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA.
²³ Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA.

Abstract

Deep Brain Stimulation can improve tremor, bradykinesia, rigidity, and axial symptoms in patients with Parkinson's disease. Potentially, improving each symptom may require stimulation of different white matter tracts. Here, we study a large cohort of patients (N = 237 from five centers) to identify tracts associated with improvements in each of the four symptom domains. Tremor improvements were associated with stimulation of tracts connected to primary motor cortex and cerebellum. In contrast, axial symptoms are associated with stimulation of tracts connected to the supplementary motor cortex and brainstem. Bradykinesia and rigidity improvements are associated with the stimulation of tracts connected to the supplementary motor and premotor cortices, respectively. We introduce an algorithm that uses these symptom-response tracts to suggest optimal stimulation parameters for DBS based on individual patient's symptom profiles. Application of the algorithm illustrates that our symptom-tract library may bear potential in personalizing stimulation treatment based on the symptoms that are most burdensome in an individual patient.

Publication types

Multicenter Study

MeSH terms

Aged
Algorithms
Cerebellum / physiopathology
Cohort Studies
Deep Brain Stimulation* / methods
Female
Humans
Hypokinesia / physiopathology
Hypokinesia / therapy
Male
Middle Aged
Motor Cortex* / physiopathology
Muscle Rigidity / therapy
Parkinson Disease* / physiopathology
Parkinson Disease* / therapy
Treatment Outcome
Tremor* / physiopathology
Tremor* / therapy
White Matter / pathology
White Matter / physiopathology

Abstract

Publication types

MeSH terms

Grants and funding