Journal
MOVEMENT DISORDERS
Volume 36, Issue 2, Pages 380-388Publisher
WILEY
DOI: 10.1002/mds.28324
Keywords
Parkinson's disease; deep brain stimulation; pallidum; globus pallidus internus; dyskinesia
Categories
Funding
- Uehara Memorial Foundation
- American Brain Foundation
- Tourette Association of America
- NIH [R01 NR014852, R01NS096008, R25NS108939]
- Donnellan/Einstein/Merz Chair
- Medtronic
- St Jude
- Functional Neuromodulation
- Boston Scientific
- Neuropace
- Parkinson's Foundation
- Michael J. Fox Foundation
- Parkinson Alliance
- Smallwood Foundation
- Bachmann-Strauss Foundation
- Tourette Syndrome Association
- UF Foundation
- Academy for Healthcare Learning
- PeerView
- Prime
- QuantiaMD
- WebMD/Medscape
- Medicus
- MedNet
- Einstein
- American Academy of Neurology
- Movement Disorders Society
- Vanderbilt University
- AbbVie
- Abbott
- Allergan
- Henry Stewart
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This study aimed to identify anatomical regions related to stimulation-induced dyskinesia (SID) in PD patients after pallidal DBS and analyze the connectivity associated with SID. The results showed that SID VTAs were primarily located in the dorsal GPi/GPe and had higher structural connectivity to certain cortical regions compared to non-SID VTAs. Differences in connectivity between motor-related cortices and subcortical regions may explain the presence or absence of SID.
Objectives The aim of this study is to identify anatomical regions related to stimulation-induced dyskinesia (SID) after pallidal deep brain stimulation (DBS) in Parkinson's disease (PD) patients and to analyze connectivity associated with SID. Methods This retrospective study analyzed the clinical and imaging data of PD patients who experienced SID during the monopolar review after pallidal DBS. We analyzed structural and functional connectivity using normative connectivity data with the volume of tissue activated (VTA) modeling. Each contact was assigned to either that producing SID (SID VTA) or that without SID (non-SID VTA). Structural and functional connectivity was compared between SID and non-SID VTAs. Optimized VTAs were also estimated using the DBS settings at 6 months after implantation. Results Of the 68 consecutive PD patients who underwent pallidal implantation, 20 patients (29%) experienced SID. SID VTAs were located more dorsally and anteriorly compared with non-SID and optimized VTAs and were primarily in the dorsal globus pallidus internus (GPi) and dorsal globus pallidus externus (GPe). SID VTAs showed significantly higher structural connectivity than non-SID VTAs to the associative cortex and supplementary motor area/premotor cortex (P< 0.0001). Simultaneously, non-SID VTAs showed greater connectivity to the primary sensory cortex, cerebellum, subthalamic nucleus, and motor thalamus (allP< 0.0004). Functional connectivity analysis showed significant differences between SID and non-SID VTAs in multiple regions, including the primary motor, premotor, and prefrontal cortices and cerebellum. Conclusion SID VTAs were primarily in the dorsal GPi/GPe. The connectivity difference between the motor-related cortices and subcortical regions may explain the presence and absence of SID. (c) 2020 International Parkinson and Movement Disorder Society
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