Microstructure predicts non-motor outcomes following Deep Brain Stimulation in Parkinson’s disease

Abstract

AbstractBackgroundDeep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment for motor and non-motor symptoms in advanced Parkinson’s disease (PD). However, considerable interindividual variability of outcomes exists. Neuroimaging based biomarkers, such as neurite orientation dispersion and density imaging (NODDI), a biophysical model based MRI-technique, have been proposed to predict clinical outcomes and therefore inform preoperative patient counselling.ObjectiveTo detect microstructural properties of brain areas associated with short-term non-motor outcomes following STN-DBS in PD.MethodsIn this prospective open-label study, 37 PD patients underwent diffusion MRI and comprehensive clinical assessments at preoperative baseline and 6-month follow-up. Neurite density index (NDI), orientation dispersion index (ODI), and fractional anisotropy (FA) were derived. Whole brain voxel-wise analysis assessed associations between microstructural metrics and non-motor outcomes corrected for multiple comparisons using a permutation-based approach.ResultsIntact microstructure within specific areas including right insular cortex, right putamen, right cingulum, and bilateral corticospinal tract were associated with greater postoperative improvement of non-motor symptom burden. Furthermore, microstructural properties of distinct brain regions were associated with postoperative changes in sleep, attention/memory, and urinary symptoms.ConclusionMicrostructural properties of distinct brain areas predict non-motor outcomes in DBS for PD. Therefore, diffusion MRI can support preoperative patient counselling and treatment selection by identifying patients with above-or below-average non-motor responses.