Project "Brain dynamics" (BRADY)
Published February 5, 2025 | Version v1
Journal article Open

Sweet spot for resting-state functional MRI effect of deep brain stimulation in dystonia lies in the lower pallidal area

Authors/Creators

  • 1. Department of Neurology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Kateřinská 30, 120 00 Prague, Czech Republic
  • 2. Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA
  • 3. Department of Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
  • 4. Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
  • 5. Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
  • 6. Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
  • 7. Department of stereotactic and radiation neurosurgery, Nemocnice Na Homolce, Prague, Czech Republic

Description

Introduction

Deep brain stimulation (DBS) of the internal globus pallidus (GPi) is a well-established, effective treatment for dystonia. Substantial variability of therapeutic success has been the one of the drivers of an ongoing debate about proper stimulation site and settings, with several indications of the notional sweet spot pointing to the lower GPi or even subpallidal area.

Methods

The presented patient-blinded, random-order study with cross-sectional verification against healthy controls enrolled 17 GPi DBS idiopathic, cervical or generalised dystonia patients to compare the effect of the stimulation in the upper and lower GPi area, with the focus on sensorimotor network connectivity and local activity measured using functional magnetic resonance.

Results

Stimulation brought both these parameters to levels closer to the state detected in healthy controls. This effect was much more pronounced during the stimulation in the lower GPi area or beneath it than in slightly higher positions, with stimulation-related changes detected by both metrics of interest in the sensorimotor cortex, striatum, thalamus and cerebellum.

Conclusions

All in all, this study not only replicated the results of previous studies on GPi DBS as a modality restoring sensorimotor network connectivity and local activity in dystonia towards the levels in healthy population, but also showed that lower GPi area or even subpallidal structures, be it white matter or even small, but essential nodes in the zona incerta as nucleus basalis of Meynert, are important regions to consider when programming DBS in dystonia patients.

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Additional details

Related works

Is supplemented by
Dataset: 10.5281/zenodo.15056362 (DOI)

Funding

Ministry of Education Youth and Sports
Brain Dynamics CZ.02.01.01/00/ 22_008/0004643
European Union
European Union’s Horizon 2020

Dates

Accepted
2025-02-04
Available
2025-02-05