PT  - JOURNAL ARTICLE
AU  - L. Okromelidze
AU  - T. Tsuboi
AU  - R.S. Eisinger
AU  - M.R. Burns
AU  - M. Charbel
AU  - M. Rana
AU  - S.S. Grewal
AU  - C.-Q. Lu
AU  - L. Almeida
AU  - K.D. Foote
AU  - M.S. Okun
AU  - E.H. Middlebrooks
TI  - Functional and Structural Connectivity Patterns Associated with Clinical Outcomes in Deep Brain Stimulation of the Globus Pallidus Internus for Generalized Dystonia
AID  - 10.3174/ajnr.A6429
DP  - 2020 Feb 13
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2020/02/13/ajnr.A6429.short
4100  - http://www.ajnr.org/content/early/2020/02/13/ajnr.A6429.full
AB  - BACKGROUND AND PURPOSE: Deep brain stimulation is a well-established treatment for generalized dystonia, but outcomes remain variable. Establishment of an imaging marker to guide device targeting and programming could possibly impact the efficacy of deep brain stimulation in dystonia, particularly in the absence of acute clinical markers to indicate benefit. We hypothesize that the stimulation-based functional and structural connectivity using resting-state fMRI and DTI can predict therapeutic outcomes in patients with generalized dystonia and deep brain stimulation.MATERIALS AND METHODS: We performed a retrospective analysis of 39 patients with inherited or idiopathic-isolated generalized dystonia who underwent bilateral globus pallidus internus deep brain stimulation. After electrode localization, the volumes of tissue activated were modeled and used as seed regions for functional and structural connectivity measures using a normative data base. Resulting connectivity maps were correlated with postoperative improvement in the Unified Dystonia Rating Scale score.RESULTS: Structural connectivity between the volumes of tissue activated and the primary sensorimotor cortex was correlated with Unified Dystonia Rating Scale improvement, while more anterior prefrontal connectivity was inversely correlated with Unified Dystonia Rating Scale improvement. Functional connectivity between the volumes of tissue activated and primary sensorimotor regions, motor thalamus, and cerebellum was most correlated with Unified Dystonia Rating Scale improvement; however, an inverse correlation with Unified Dystonia Rating Scale improvement was seen in the supplemental motor area and premotor cortex.CONCLUSIONS: Functional and structural connectivity with multiple nodes of the motor network is associated with motor improvement in patients with generalized dystonia undergoing deep brain stimulation. Results from this study may serve as a basis for future development of clinical markers to guide deep brain stimulation targeting and programming in dystonia.ACPCanterior/posterior commissureDBSdeep brain stimulationGPiglobus pallidus internusMNIMontreal Neurological InstituteUDRSUnified Dystonia Rating ScaleVTAvolume of tissue activated