Anterior lead location predicts verbal fluency decline following STN-DBS in Parkinson's disease |
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| Institution: | 1. University of Michigan – Michigan Medicine, Department of Psychiatry – Neuropsychology Section, 2101 Commonwealth Blvd, Ste C., Ann Arbor, MI, 48105, USA;2. University of Michigan – Michigan Medicine, Department of Neurosurgery, 1500 E. Medical Center Drive, SPC 5338, Ann Arbor, MI, 48109, USA;1. Center for Neurology and Hertie-Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Tübingen, Germany;2. Department of Neurology, Julius-Maximilians-University, Würzburg, Germany;3. Department of Neurology, Christian-Albrechts-University, Kiel, Germany;4. High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany;5. Department of Biomedical Magnetic Resonance, University Hospital Tübingen, Germany;6. Department of General Psychiatry, University of Tübingen, Germany;7. Department of Pediatric Neurology and Developmental Medicine, Children''s Hospital, University of Tübingen, Germany;8. Experimental Pediatric Neuroimaging Group, Pediatric Neurology & Department of Neuroradiology, University Hospital Tübingen, Germany;1. James J. and Joan A. Gardner Family Center for Parkinson''s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA;2. Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, United States;3. Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA;4. Department of Laboratory Medicine, Clinical Research Center, Karolinska Institutet, Stockholm, Sweden;5. Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institute, 171 76, Stockholm, Sweden;1. RWTH Aachen University, Department of Neurology, Aachen, Germany;2. JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Juelich Research Center GmbH and RWTH Aachen University, Aachen, Germany;3. Department of Neurology with Institute of Sleep Medicine and Neuromuscular Disease, University Hospital Muenster, Muenster, Germany;4. Medical University Innsbruck, Department of Neurology, Innsbruck, Austria;5. Division for Clinical Cognitive Sciences, Department of Neurology, University Hospital RWTH, Aachen, Germany;6. Institute for Neuroscience and Medicine (INM-4), Research Center Juelich GmbH, Germany;1. Department of Neurology, Wake Forest School of Medicine, 1 Medical Center, Boulevard, Winston-Salem, NC, 27157, USA;2. Icahn School of Medicine at Mount Sinai, 1000 10th Ave., Suite 10c, New York, NY, 10019, USA;3. Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV, 89117, USA;4. Cleveland Clinic, 9500 Euclid Ave/S2, Cleveland, OH, 44195, USA;5. Pennsylvania State University – Milton S. Hershey Medical Center, 30 Hope Drive, Suite 2800 P.O. Box 859, Mail Code EC037, Hershey, PA, 17033, USA;6. Mount Sinai Medical Center, 1000 10th Ave, Suite 10C, Brooklyn, NY, 11217, USA;7. Henry Ford Medical Group, 6777 West Maple Road, West Bloomfield, MI, 48322, USA;8. Baylor College of Medicine, 7200 Cambridge St, 9th Floor, Houston, TX, 77030, USA;9. Weill Cornell Medicine, 428 E 72nd Street, STE 400, NY, NY, 10021, USA;10. University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE, 68198, USA;11. Rush University Medical Center, 1725 West Harrison St. Suite 755, Chicago, IL, 60612, USA;12. UCDavis, 4860 Y Street, ACC Building, Suite 3700, Sacramento, CA, 95817, USA;13. Penn State Health, Milton S. Hershey Medical Center, Department of Neurosurgery, 30 Hope Drive, EC110, Hershey, PA, 17033, USA;14. Northwestern University Feinberg School of Medicine Department of Neurosurgery, 676 N St. Clair St, Suite 2210, Chicago, IL, USA;1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;2. Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China;3. Beijing Key Laboratory of Neurostimulation, Beijing, China;4. Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China |
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| Abstract: | IntroductionVerbal fluency (VF) decline is a well-documented cognitive effect of Deep Brain Stimulation of the subthalamic nucleus (STN-DBS) in patients with Parkinson's disease (PD). This decline may be associated with disruption to left-sided frontostriatal circuitry involving the anteroventral non-motor area of the STN. While recent studies have examined the impact of lead location in relation to functional STN subdivisions on VF outcomes, results have been mixed and methods have been limited by atlas-based location mapping.MethodsParticipants included 59 individuals with PD who underwent bilateral STN-DBS. Each participant's active contact location was determined in an atlas-independent fashion, relative to their individual MR-visualized STN midpoint. Multiple linear regression was used to examine lead location in each direction as a predictor of phonemic and semantic VF decline, controlling for demographic and disease variables.ResultsMore anterior lead locations relative to the STN midpoint in the left hemisphere predicted greater phonemic VF decline (B = ?2.34, B SE = 1.08, β = ?0.29, sr2 = 0.08). Lead location was not a significant predictor of semantic VF decline.ConclusionUsing an individualized atlas-independent approach, present findings suggest that more anterior stimulation of the left STN may uniquely contribute to post-DBS VF decline. This is consistent with models in which the anterior STN represents a “non-motor” functional subdivision with connections to frontal regions, e.g., the left dorsal prefrontal cortex. Future studies should investigate the effect of DBS lead trajectory on VF outcomes. |
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| Keywords: | Parkinson's disease Deep Brain Stimulation Active contact location Verbal fluency |
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