Universität zu Köln

Strelow, Joshua N., Baldermann, Juan C., Dembek, Till A., Jergas, Hannah, Petry-Schmelzer, Jan N., Schott, Frederik, Dafsari, Haidar S. ORCID: 0000-0001-8849-4233, Moll, Christian K. E., Hamel, Wolfgang, Gulberti, Alessandro, Visser-Vandewalle, Veerle ORCID: 0000-0002-5274-7929, Fink, Gereon R. ORCID: 0000-0002-8230-1856, Potter-Nerger, Monika and Barbe, Michael T. (2022). Structural Connectivity of Subthalamic Nucleus Stimulation for Improving Freezing of Gait. J. Parkinsons Dis., 12 (4). S. 1251 - 1268. AMSTERDAM: IOS PRESS. ISSN 1877-718X

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Abstract

Background: Freezing of gait (FOG) is among the most common and disabling symptoms of Parkinson's disease (PD). Studies show that deep brain stimulation (DBS) of the subthalamic nucleus (STN) can reduce FOG severity. However, there is uncertainty about pathways that need to be modulated to improve FOG. Objective: To investigate whether STN-DBS effectively reduces FOG postoperatively and whether structural connectivity of the stimulated tissue explains variance of outcomes. Methods: We investigated 47 patients withPDand preoperative FOG. Freezing prevalence and severity was primarily assessed using the Freezing of Gait Questionnaire (FOG-Q). In a subset of 18 patients, provoked FOG during a standardized walking course was assessed. Using a publicly available model of basal-ganglia pathways we determined stimulation-dependent connectivity associated with postoperative changes in FOG. A region-of-interest analysis to a priori defined mesencephalic regions was performed using a disease-specific normative connectome. Results: Freezing of gait significantly improved six months postoperatively, marked by reduced frequency and duration of freezing episodes. Optimal stimulation volumes for improvingFOGstructurally connected to motor areas, the prefrontal cortex and to the globus pallidus. Stimulation of the lenticular fasciculus was associated with worsening of FOG. This connectivity profile was robust in a leave-one-out cross-validation. Subcortically, stimulation of fibers crossing the pedunculopontine nucleus and the substantia nigra correlated with postoperative improvement. Conclusion: STN-DBS can alleviate FOG severity by modulating specific pathways structurally connected to prefrontal and motor cortices. More differentiated FOG assessments may allow to differentiate pathways for specific FOG subtypes in the future.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Strelow, Joshua N. UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldermann, Juan C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Dembek, Till A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Jergas, Hannah UNSPECIFIED UNSPECIFIED UNSPECIFIED Petry-Schmelzer, Jan N. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schott, Frederik UNSPECIFIED UNSPECIFIED UNSPECIFIED Dafsari, Haidar S. UNSPECIFIED orcid.org/0000-0001-8849-4233 UNSPECIFIED Moll, Christian K. E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hamel, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Gulberti, Alessandro UNSPECIFIED UNSPECIFIED UNSPECIFIED Visser-Vandewalle, Veerle UNSPECIFIED orcid.org/0000-0002-5274-7929 UNSPECIFIED Fink, Gereon R. UNSPECIFIED orcid.org/0000-0002-8230-1856 UNSPECIFIED Potter-Nerger, Monika UNSPECIFIED UNSPECIFIED UNSPECIFIED Barbe, Michael T. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-681519
DOI:	10.3233/JPD-212997
Journal or Publication Title:	J. Parkinsons Dis.
Volume:	12
Number:	4
Page Range:	S. 1251 - 1268
Date:	2022
Publisher:	IOS PRESS
Place of Publication:	AMSTERDAM
ISSN:	1877-718X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language DEEP-BRAIN-STIMULATION; PARKINSONS-DISEASE; AREA STIMULATION; PEDUNCULOPONTINE; LEVODOPA; DISORDERS; REGION; FALLS; TRIAL; DBS Multiple languages Neurosciences Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/68151