Use of Functional Magnetic Resonance Imaging to Assess How Motor Phenotypes of Parkinson's Disease Respond to Deep Brain Stimulation
Marisa DiMarzio PhD
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Search for more papers by this authorRadhika Madhavan PhD
GE Global Research Center, Niskayuna, NY, USA
Search for more papers by this authorJulia Prusik MPH
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
Search for more papers by this authorMichael Gillogly BA/BS RN
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
Search for more papers by this authorTanweer Rashid PhD
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Search for more papers by this authorJacquelyn MacDonell MS
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Search for more papers by this authorIlknur Telkes MSc, PhD
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Search for more papers by this authorPaul Feustel PhD
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Search for more papers by this authorMichael D Staudt MD, MSc
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
Search for more papers by this authorDamian S. Shin PhD
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Department of Neurology, Albany Medical Center, Albany, NY, USA
Search for more papers by this authorJennifer Durphy MD
Department of Neurology, Albany Medical Center, Albany, NY, USA
Search for more papers by this authorRoy Hwang MD
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
Search for more papers by this authorEra Hanspal MD
Department of Neurology, Albany Medical Center, Albany, NY, USA
Search for more papers by this authorCorresponding Author
Julie G. Pilitsis MD, PhD
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
Address Correspondence to: Julie G. Pilitsis, MD, PhD, Department of Neuroscience and Experimental Therapeutics and Professor of Neurosurgery, 47 New Scotland Ave, MC 10, Physicians Pavilion, 1st Floor, Albany, NY 12208, USA. Email: [email protected]Search for more papers by this authorMarisa DiMarzio PhD
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Search for more papers by this authorRadhika Madhavan PhD
GE Global Research Center, Niskayuna, NY, USA
Search for more papers by this authorJulia Prusik MPH
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
Search for more papers by this authorMichael Gillogly BA/BS RN
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
Search for more papers by this authorTanweer Rashid PhD
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Search for more papers by this authorJacquelyn MacDonell MS
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Search for more papers by this authorIlknur Telkes MSc, PhD
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Search for more papers by this authorPaul Feustel PhD
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Search for more papers by this authorMichael D Staudt MD, MSc
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
Search for more papers by this authorDamian S. Shin PhD
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Department of Neurology, Albany Medical Center, Albany, NY, USA
Search for more papers by this authorJennifer Durphy MD
Department of Neurology, Albany Medical Center, Albany, NY, USA
Search for more papers by this authorRoy Hwang MD
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
Search for more papers by this authorEra Hanspal MD
Department of Neurology, Albany Medical Center, Albany, NY, USA
Search for more papers by this authorCorresponding Author
Julie G. Pilitsis MD, PhD
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
Address Correspondence to: Julie G. Pilitsis, MD, PhD, Department of Neuroscience and Experimental Therapeutics and Professor of Neurosurgery, 47 New Scotland Ave, MC 10, Physicians Pavilion, 1st Floor, Albany, NY 12208, USA. Email: [email protected]Search for more papers by this authorAbstract
Background
Deep brain stimulation (DBS) is a well-accepted treatment of Parkinson's disease (PD). Motor phenotypes include tremor-dominant (TD), akinesia-rigidity (AR), and postural instability gait disorder (PIGD). The mechanism of action in how DBS modulates motor symptom relief remains unknown.
Objective
Blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) was used to determine whether the functional activity varies in response to DBS depending on PD phenotypes.
Materials and Methods
Subjects underwent an fMRI scan with DBS cycling ON and OFF. The effects of DBS cycling on BOLD activation in each phenotype were documented through voxel-wise analysis. For each region of interest, ANOVAs were performed using T-values and covariate analyses were conducted. Further, a correlation analysis was performed comparing stimulation settings to T-values. Lastly, T-values of subjects with motor improvement were compared to those who worsened.
Results
As a group, BOLD activation with DBS-ON resulted in activation in the motor thalamus (p < 0.01) and globus pallidus externa (p < 0.01). AR patients had more activation in the supplementary motor area (SMA) compared to PIGD (p < 0.01) and TD cohorts (p < 0.01). Further, the AR cohort had more activation in primary motor cortex (MI) compared to the TD cohort (p = 0.02). Implanted nuclei (p = 0.01) and phenotype (p = <0.01) affected activity in MI and phenotype alone affected SMA activity (p = <0.01). A positive correlation was seen between thalamic activation and pulse-width (p = 0.03) and between caudate and total electrical energy delivered (p = 0.04).
Conclusions
These data suggest that DBS modulates network activity differently based on patient motor phenotype. Improved understanding of these differences may further our knowledge about the mechanisms of DBS action on PD motor symptoms and to optimize treatment.
Supporting Information
| Filename | Description |
|---|---|
| ner13160-sup-0001-FigureS1.pngapplication/png, 442.6 KB | Supplementary Figure 1 fMRI processing. 1A) Shows an example of the functional images that are obtained. These images are further aligned to the structural T1 image. 1B) Shows an example of the structural T1 anatomical images in which the functional data would be aligned to. Red arrows point to the DBS electrodes surrounded by artifact, which was easy to detect. Brain regions, which appeared to be affected by DBS artifact, were not included in the analysis. 1C) An example of the AAL atlas that was used to establish ROIs. MNI coordinates presented in SPM were observed and compared with the AAL atlas. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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