Evidence map›Paper›PMID 40532683›Full record

ArticleStereotactic and functional neurosurgery2025

Structural Connectivity of the Basal Ganglia from Patient-Individual Tractography Is Key for Understanding the Effects of Deep Brain Stimulation in Parkinson's Disease.

Ricardo Loução, Martin Kocher, Gregor Alexander Brandt, Jan Niklas Petry-Schmelzer, Michael Barbe, Haidar Dafsari, Josef Mana, Robert Jech, Jochen Wirths, Veerle Visser-Vandewalle and 10 more

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Article in Stereotactic and functional neurosurgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Ricardo LouçãoDepartment of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Martin KocherDepartment of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Gregor Alexander BrandtDepartment of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Jan Niklas Petry-SchmelzerDepartment of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Michael BarbeDepartment of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Haidar DafsariDepartment of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Josef ManaDepartment of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czechia.
Robert JechDepartment of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czechia.
Jochen WirthsDepartment of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Veerle Visser-VandewalleDepartment of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Pablo AndradeDepartment of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
NEURIPIDES Study Group
Halim BaqapuriMental Health and Neuroscience Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands.
Michael LuehrsDepartment of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
David E J LindenMental Health and Neuroscience Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands.
Brendan SantyrDivision of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Andres LozanoDivision of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Alessandro BongioanniCognitive Neuroimaging Unit, CEA, INSERM, Université Paris-Saclay, NeuroSpin Center, Gif-sur-Yvette, France.
Bechir JarrayaCognitive Neuroimaging Unit, CEA, INSERM, Université Paris-Saclay, NeuroSpin Center, Gif-sur-Yvette, France.
Tolga CukurDepartment of Electrical and Electronics Engineering, National Magnetic Resonance Research Center (UMRAM), Bilkent University, Ankara, Turkey.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionIn Parkinson's disease (PD) patients, modulation of the fibre tracts of the cortico-basal ganglia-thalamo-cortical loop is the presumed mechanism of action of deep brain stimulation (DBS) of the subthalamic nucleus (STN). Therefore, we explored patient-individual cortical structural connectivity of the volume of tissue activated (VTA), as well as DBS-induced modulation of fibre tracts connecting the STN with cortical and subcortical nodes, and their correlation with therapeutic effects.

methodsA retrospective cohort of n = 69 PD patients treated with bilateral DBS of the STN was analysed. Clinical response was assessed from the DBS-induced change in the UPDRS-III motor scores (total and symptom-specific sub-scores) under regular medication after a median follow-up of 9.0 (range 2.6-20.2) months. Tractography based on patient-individual diffusion-weighted MRI was employed in two ways. Whole-brain tractography was used to identify the cortical connections of fibres passing the VTAs, and reconstruction of specific white matter pathways of the motor loop connecting the STN with the basal ganglia and cortex was used to identify the proportion of fibres within these pathways which was modulated by STN-DBS. This proportion of pathway modulation was used in a correlative analysis with clinical outcomes.

resultsFibres traversing the VTAs were primarily connected to the supplementary motor area (SMA) and to a lesser degree to the premotor cortex. Within the pathways connecting the STN with the cortical and subcortical nodes, on average 30-40% (range 10-80%) of the fibres were modulated by STN-DBS. This proportion correlated significantly with the percentage change in UPDRS motor score for fibres connecting the STN with the SMA (ρ = 0.28), pre-SMA (ρ = 0.26), ventral and dorsal premotor cortices (ρ = 0.26 and ρ = 0.29, respectively), and the globus pallidus externus (ρ = 0.26) and internus (ρ = 0.29). Also, good clinical responses for both tremor and rigidity were associated with a significantly (p < 0.05) higher proportion of modulated fibres for the same cortico- and sub-cortico-STN connections.

conclusionPatient-individual tractography reveals that, in PD, most of the cortical fibres traversing the VTA are connected to the SMA. In addition, clinical efficacy is related to the proportion of DBS-affected fibres connecting the STN with nodes of both the hyperdirect (cortex-STN) and the indirect pathways (STN-basal ganglia). As such, patient-specific tractography, in particular in the basal ganglia, could be used in a clinical context as a tool to guide therapy.

Indexed as

Basal GangliaDeep Brain StimulationDiffusion Tensor ImagingParkinson DiseaseAgedFemaleHumansMaleMiddle AgedNeural PathwaysRetrospective StudiesSubthalamic NucleusDeep brain stimulationParkinson’s diseaseStructural connectivityTractography

Identifiers

PMID40532683
PMCPMC12453574

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