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Subthalamic nucleus deep brain stimulation (STN-DBS) alleviates motor symptoms of Parkinson’s disease (PD), thereby improving quality of life. However, quantitative brain markers to evaluate DBS responses and select suitable patients for surgery are lacking. Here, we used metabolic brain imaging to identify a reproducible STN-DBS network for which...

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... correlation, two-tailed) (Fig. 2C, right). The stability of these relationships was supported by the excellent test-retest reliability (ICC = 0.97) of the STN StimNet subject scores over an 8-week interval in PD patients (n = ...
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... individuals likewise underwent FDG PET on-and off-stimulation on consecutive days. In this patient sample, stimulation-induced increases in network expression were observed (p < 0.05; Student's paired ttest, two-tailed), which correlated with concurrent improvements in total motor ratings (r = 0.66, p < 0.05; Pearson correlation, two-tailed) (Fig. ...
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... determine the specicity of the STN StimNet for PD interventions of comparable clinical ecacy, we computed changes in STN StimNet expression in a number of treatment cohorts (Fig. 2E). For example, levodopa administration (yellow bar) acts by repleting nigrostriatal dopamine levels. Despite similar clinical responses, this treatment had no effect on STN StimNet expression (p > 0.9, compared to testretest; Welch's ANOVA, post-hoc Dunnett T3). Stimulation of the internal globus pallidus (GPi) (brown bar), located ...
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... we considered the possibility that preoperative measurements of network expression predict clinical outcomes in PD patients. This was motivated by the signicant correlation that was observed between stimulation-mediated motor benet and off-stimulation measurements of network expression in both STN-DBS groups (Site 1: hemisphere: r=-0.52, p < 0.01 (Fig. S2A); whole brain: r=-0.66, p < 0.02 (Fig. 4A); Site 2: whole brain: r=-0.68, p < 0.05 (Fig. 4B)). Accurate predictions of motor responses to stimulation were also observed in FDG PET scans acquired preoperatively (PRE), i.e., before electrode implantation surgery. Indeed, in 12 Site 1 patients, preoperative STN StimNet expression values ...
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... also observed in FDG PET scans acquired preoperatively (PRE), i.e., before electrode implantation surgery. Indeed, in 12 Site 1 patients, preoperative STN StimNet expression values obtained an average of 8 months before DBS surgery, correlated with motor benet recorded approximately 17.3 months after surgery (hemisphere: r=-0.73, p < 0.0001 ( Fig. S2B), whole brain: r=-0.54, p < 0.05 (Fig. ...
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... in scans of fractional amplitude of low frequency uctuations (fALFF) derived from the original time-series data. We found that the resulting values signicantly correlated with the motor benet recorded independently in these individuals approximately 6 months after surgery (whole brain r=-0.79, p < 0.02 ( Fig. 4D), hemisphere: r=-0.49, p < 0.05 (Fig. ...
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... in expression values for the two networks can be explained by their distinct topographies. The STN StimNet includes a group of connected regions that are modulated by stimulation which are not necessarily affected (either directly or indirectly) by the underlying disease process. This included regions with negative weights (blue clusters in Fig. 2A) localized to the sensorimotor cortex (SMC) and to the contralateral cerebellar hemisphere and vermis, which denoted stimulation-induced reductions as part of the network. Elements of these regions also contribute to the PDRP (yellow clusters in Fig. S3), reecting increased metabolic activity as part of the disease. These areas likely ...
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... the network. Elements of these regions also contribute to the PDRP (yellow clusters in Fig. S3), reecting increased metabolic activity as part of the disease. These areas likely mediators of motor symptoms of PD, particularly tremor [27,28]. By the same token, the STN StimNet also contains regional elements with positive weights (red clusters in Fig. 2A), which denote areas in which STN stimulation increased local metabolic activity as part of the network. These regions include the subthalamic complex (the STN and adjacent substantia nigra) and its projection ventrally to the pontine nuclei. Positive region weights on the network were also observed in the SMA complex (preSMA and SMA), ...
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... StimNet) were computed in prospective scan data using the topographical prole rating algorithm [65] (ScAnVP 7.0, available at www.feinsteinneuroscience.org). In this study, STN StimNet scores were computed for each hemisphere (implanted electrode) separately as well as for the whole brain. Only when comparing STN StimNet expression across cohorts (Figs. 2E, 4C right and 5), values were z-scored to a group of matched healthy controls (n = ...

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