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Left Prefrontal Connectivity Links Subthalamic Stimulation with Depressive Symptoms
Author(s) -
Irmen Friederike,
Horn Andreas,
Mosley Philip,
Perry Alistair,
PetrySchmelzer Jan Niklas,
Dafsari Haidar S.,
Barbe Michael,
VisserVandewalle Veerle,
Schneider GerdHelge,
Li Ningfei,
Kübler Dorothee,
Wenzel Gregor,
Kühn Andrea A.
Publication year - 2020
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.25734
Subject(s) - deep brain stimulation , subthalamic nucleus , connectome , prefrontal cortex , physical medicine and rehabilitation , psychology , cohort , depressive symptoms , major depressive disorder , neuroscience , parkinson's disease , medicine , disease , cognition , functional connectivity
Objective Subthalamic nucleus deep brain stimulation (STN‐DBS) in Parkinson's disease (PD) not only stimulates focal target structures but also affects distributed brain networks. The impact this network modulation has on non‐motor DBS effects is not well‐characterized. By focusing on the affective domain, we systematically investigate the impact of electrode placement and associated structural connectivity on changes in depressive symptoms following STN‐DBS, which have been reported to improve, worsen, or remain unchanged. Methods Depressive symptoms before and after STN‐DBS surgery were documented in 116 patients with PD from 3 DBS centers (Berlin, Queensland, and Cologne). Based on individual electrode reconstructions, the volumes of tissue activated (VTAs) were estimated and combined with normative connectome data to identify structural connections passing through VTAs. Berlin and Queensland cohorts formed a training and cross‐validation dataset used to identify structural connectivity explaining change in depressive symptoms. The Cologne data served as the test‐set for which depressive symptom change was predicted. Results Structural connectivity was linked to depressive symptom change under STN‐DBS. An optimal connectivity map trained on the Berlin cohort could predict changes in depressive symptoms in Queensland patients and vice versa. Furthermore, the joint training‐set map predicted changes in depressive symptoms in the independent test‐set. Worsening of depressive symptoms was associated with left prefrontal connectivity. Interpretation Fibers connecting the electrode with left prefrontal areas were associated with worsening of depressive symptoms. Our results suggest that for the left STN‐DBS lead, placement impacting fibers to left prefrontal areas should be avoided to maximize improvement of depressive symptoms. ANN NEUROL 2020;87:962–975