Cortical network fingerprints predict deep brain stimulation outcome in dystonia

Abstract

Background: Deep brain stimulation (DBS) is an effective evidence-based therapy for dystonia. However, no unequivocal predictors of therapy responses exist. We investigate whether patients optimally responding to DBS present distinct brain network organization and structural patterns.Methods: Based on a German multicentre cohort of eighty-two dystonia patients with segmental and generalized dystonia, who received DBS implantation in the globus pallidus internus patients were classified based on the clinical response 36 months after DBS, as superior-outcome group or moderate-outcome group, as above or below 70% motor improvement, respectively. Fifty-one patients met MRI-quality and treatment response requirements (mean age 51.3 ± 13.2 years; 25 female) and were included into further analysis. From preoperative MRI we assessed cortical thickness and structural covariance, which were then fed into network analysis using graph theory. We designed a support vector machine to classify subjects for the clinical response based on group network properties and individual grey matter fingerprints. Results:The moderate-outcome group showed cortical atrophy mainly in the sensorimotor and visuomotor areas and disturbed network topology in these regions. From all the structural integrity of the cortical mantle explained about 45% of the stimulation amplitude.Classification analyses achieved 88% of accuracy using individual grey matter atrophy patterns to predict DBS outcome. Conclusions:The analysis of cortical integrity and network properties could be developed into independent predictors to identify dystonia patients who benefit from DBS.

Infratentorial Morphometry and Deep Brain Stimulation Outcome in Cervical Dystonia

“…‫כ‬ 100 The T out for each patient was obtained at the best improvement score between three and five years post-DBS implantation to provide a long-term clinically stabilised score, (35)(36)(37) excluding two patients who due to the recency of date of implantation, best two-year post-operative scores were used. Unlike movement disorders such as Parkinson's disease, at shorter time periods, the response of dystonia to DBS is not stable, suggested to be related to motor-plasticity effects from pallidal DBS.…”