Stimulation of the Presupplementary Motor Area Cluster of the Subthalamic Nucleus Predicts More Consistent Clinical Outcomes
Kähkölä, Johannes; Lahtinen, Maija; Keinänen, Tuija; Katisko, Jani (2022-12-30)
Wolters Kluwer
30.12.2022
Kähkölä, J., Lahtinen, M., Keinänen, T., & Katisko, J. (2023). Stimulation of the presupplementary motor area cluster of the subthalamic nucleus predicts more consistent clinical outcomes. Neurosurgery, 92(5), 1058–1065. https://doi.org/10.1227/neu.0000000000002292
https://rightsstatements.org/vocab/InC/1.0/
This is a pre-copyedited, author-produced version of an article accepted for publication in Neurosurgery. The published version of record Kähkölä, J., Lahtinen, M., Keinänen, T., & Katisko, J. (2023). Stimulation of the presupplementary motor area cluster of the subthalamic nucleus predicts more consistent clinical outcomes. Neurosurgery, 92(5), 1058–1065 is available online at: https://doi.org/10.1227/neu.0000000000002292
https://rightsstatements.org/vocab/InC/1.0/
This is a pre-copyedited, author-produced version of an article accepted for publication in Neurosurgery. The published version of record Kähkölä, J., Lahtinen, M., Keinänen, T., & Katisko, J. (2023). Stimulation of the presupplementary motor area cluster of the subthalamic nucleus predicts more consistent clinical outcomes. Neurosurgery, 92(5), 1058–1065 is available online at: https://doi.org/10.1227/neu.0000000000002292
https://rightsstatements.org/vocab/InC/1.0/
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:oulu-202505143401
https://urn.fi/URN:NBN:fi:oulu-202505143401
Tiivistelmä
Abstract
Background:
The development of diffusion tensor imaging and tractography has raised increasing interest in the functional targeting of deep brain stimulation of the subthalamic nucleus (STN) in Parkinson disease.
Objective:
To study, using deterministic tractography, the functional subdivisions of the STN and hyperdirect white matter connections located between the STN and the medial frontal cortex, especially the presupplementary motor area (preSMA), SMA, primary motor area (M1), and dorsolateral premotor cortex, and to study retrospectively whether this information correlates with clinical outcome.
Methods:
Twenty-two patients with Parkinson disease who underwent STN deep brain stimulation were analyzed. Using 3 T MR images, the medial frontal cortex was manually segmented into preSMA, SMA, M1, and dorsolateral premotor cortex, which were then used to determine the functional subdivisions of the lateral border of the STN. The intersectional quantities of the volume of activated tissue (VAT) and the hyperdirect white matter connections were calculated. The results were combined with clinical data including unilateral 12-month postoperative motor outcome and levodopa equivalent daily dose.
Results:
Stimulated clusters of the STN were connected mostly to the cortical SMA and preSMA regions. Patients with primarily preSMA cluster stimulation (presmaVAT% ≥ 50%) had good responses to the treatment with unilateral motor improvement over 40% and levodopa equivalent daily dose reduction over 60%. Larger VAT was not found to correlate with better patient outcomes.
Conclusion::
Our study is the first to suggest that stimulating, predominantly, the STN cluster where preSMA hyperdirect pathways are located, could be predictive of more consistent treatment results.
Background:
The development of diffusion tensor imaging and tractography has raised increasing interest in the functional targeting of deep brain stimulation of the subthalamic nucleus (STN) in Parkinson disease.
Objective:
To study, using deterministic tractography, the functional subdivisions of the STN and hyperdirect white matter connections located between the STN and the medial frontal cortex, especially the presupplementary motor area (preSMA), SMA, primary motor area (M1), and dorsolateral premotor cortex, and to study retrospectively whether this information correlates with clinical outcome.
Methods:
Twenty-two patients with Parkinson disease who underwent STN deep brain stimulation were analyzed. Using 3 T MR images, the medial frontal cortex was manually segmented into preSMA, SMA, M1, and dorsolateral premotor cortex, which were then used to determine the functional subdivisions of the lateral border of the STN. The intersectional quantities of the volume of activated tissue (VAT) and the hyperdirect white matter connections were calculated. The results were combined with clinical data including unilateral 12-month postoperative motor outcome and levodopa equivalent daily dose.
Results:
Stimulated clusters of the STN were connected mostly to the cortical SMA and preSMA regions. Patients with primarily preSMA cluster stimulation (presmaVAT% ≥ 50%) had good responses to the treatment with unilateral motor improvement over 40% and levodopa equivalent daily dose reduction over 60%. Larger VAT was not found to correlate with better patient outcomes.
Conclusion::
Our study is the first to suggest that stimulating, predominantly, the STN cluster where preSMA hyperdirect pathways are located, could be predictive of more consistent treatment results.
Kokoelmat
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