Anterior lead location predicts verbal fluency decline following STN-DBS in Parkinson's disease
Verbal fluency (VF) decline is a well-documented cognitive effect of Deep Brain Stimulation of the subthalamic nucleus (STN-DBS) in patients with Parkinson's disease (PD). This decline may be associated with disruption to left-sided frontostriatal circuitry involving the anteroventral non-motor...
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Published in | Parkinsonism & related disorders Vol. 92; pp. 36 - 40 |
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Language | English |
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01.11.2021
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Abstract | Verbal fluency (VF) decline is a well-documented cognitive effect of Deep Brain Stimulation of the subthalamic nucleus (STN-DBS) in patients with Parkinson's disease (PD). This decline may be associated with disruption to left-sided frontostriatal circuitry involving the anteroventral non-motor area of the STN. While recent studies have examined the impact of lead location in relation to functional STN subdivisions on VF outcomes, results have been mixed and methods have been limited by atlas-based location mapping.
Participants included 59 individuals with PD who underwent bilateral STN-DBS. Each participant's active contact location was determined in an atlas-independent fashion, relative to their individual MR-visualized STN midpoint. Multiple linear regression was used to examine lead location in each direction as a predictor of phonemic and semantic VF decline, controlling for demographic and disease variables.
More anterior lead locations relative to the STN midpoint in the left hemisphere predicted greater phonemic VF decline (B = −2.34, B SE = 1.08, β = −0.29, sr2 = 0.08). Lead location was not a significant predictor of semantic VF decline.
Using an individualized atlas-independent approach, present findings suggest that more anterior stimulation of the left STN may uniquely contribute to post-DBS VF decline. This is consistent with models in which the anterior STN represents a “non-motor” functional subdivision with connections to frontal regions, e.g., the left dorsal prefrontal cortex. Future studies should investigate the effect of DBS lead trajectory on VF outcomes.
•Atlas-independent methods more fully account for individual anatomical variability.•This individualized approach can more precisely measure DBS lead location.•More anterior STN lead location predicts post-DBS phonemic verbal fluency decline.•Anterior STN stimulation may disrupt non-motor (cognitive) frontostriatal networks. |
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AbstractList | Verbal fluency (VF) decline is a well-documented cognitive effect of Deep Brain Stimulation of the subthalamic nucleus (STN-DBS) in patients with Parkinson's disease (PD). This decline may be associated with disruption to left-sided frontostriatal circuitry involving the anteroventral non-motor area of the STN. While recent studies have examined the impact of lead location in relation to functional STN subdivisions on VF outcomes, results have been mixed and methods have been limited by atlas-based location mapping.
Participants included 59 individuals with PD who underwent bilateral STN-DBS. Each participant's active contact location was determined in an atlas-independent fashion, relative to their individual MR-visualized STN midpoint. Multiple linear regression was used to examine lead location in each direction as a predictor of phonemic and semantic VF decline, controlling for demographic and disease variables.
More anterior lead locations relative to the STN midpoint in the left hemisphere predicted greater phonemic VF decline (B = −2.34, B SE = 1.08, β = −0.29, sr2 = 0.08). Lead location was not a significant predictor of semantic VF decline.
Using an individualized atlas-independent approach, present findings suggest that more anterior stimulation of the left STN may uniquely contribute to post-DBS VF decline. This is consistent with models in which the anterior STN represents a “non-motor” functional subdivision with connections to frontal regions, e.g., the left dorsal prefrontal cortex. Future studies should investigate the effect of DBS lead trajectory on VF outcomes.
•Atlas-independent methods more fully account for individual anatomical variability.•This individualized approach can more precisely measure DBS lead location.•More anterior STN lead location predicts post-DBS phonemic verbal fluency decline.•Anterior STN stimulation may disrupt non-motor (cognitive) frontostriatal networks. INTRODUCTIONVerbal fluency (VF) decline is a well-documented cognitive effect of Deep Brain Stimulation of the subthalamic nucleus (STN-DBS) in patients with Parkinson's disease (PD). This decline may be associated with disruption to left-sided frontostriatal circuitry involving the anteroventral non-motor area of the STN. While recent studies have examined the impact of lead location in relation to functional STN subdivisions on VF outcomes, results have been mixed and methods have been limited by atlas-based location mapping. METHODSParticipants included 59 individuals with PD who underwent bilateral STN-DBS. Each participant's active contact location was determined in an atlas-independent fashion, relative to their individual MR-visualized STN midpoint. Multiple linear regression was used to examine lead location in each direction as a predictor of phonemic and semantic VF decline, controlling for demographic and disease variables. RESULTSMore anterior lead locations relative to the STN midpoint in the left hemisphere predicted greater phonemic VF decline (B = -2.34, B SE = 1.08, β = -0.29, sr2 = 0.08). Lead location was not a significant predictor of semantic VF decline. CONCLUSIONUsing an individualized atlas-independent approach, present findings suggest that more anterior stimulation of the left STN may uniquely contribute to post-DBS VF decline. This is consistent with models in which the anterior STN represents a "non-motor" functional subdivision with connections to frontal regions, e.g., the left dorsal prefrontal cortex. Future studies should investigate the effect of DBS lead trajectory on VF outcomes. Verbal fluency (VF) decline is a well-documented cognitive effect of Deep Brain Stimulation of the subthalamic nucleus (STN-DBS) in patients with Parkinson's disease (PD). This decline may be associated with disruption to left-sided frontostriatal circuitry involving the anteroventral non-motor area of the STN. While recent studies have examined the impact of lead location in relation to functional STN subdivisions on VF outcomes, results have been mixed and methods have been limited by atlas-based location mapping. Participants included 59 individuals with PD who underwent bilateral STN-DBS. Each participant's active contact location was determined in an atlas-independent fashion, relative to their individual MR-visualized STN midpoint. Multiple linear regression was used to examine lead location in each direction as a predictor of phonemic and semantic VF decline, controlling for demographic and disease variables. More anterior lead locations relative to the STN midpoint in the left hemisphere predicted greater phonemic VF decline (B = -2.34, B SE = 1.08, β = -0.29, sr = 0.08). Lead location was not a significant predictor of semantic VF decline. Using an individualized atlas-independent approach, present findings suggest that more anterior stimulation of the left STN may uniquely contribute to post-DBS VF decline. This is consistent with models in which the anterior STN represents a "non-motor" functional subdivision with connections to frontal regions, e.g., the left dorsal prefrontal cortex. Future studies should investigate the effect of DBS lead trajectory on VF outcomes. |
Author | Cook Maher, Amanda Persad, Carol Patil, Parag G. Askari, Asra Greif, Taylor R. |
Author_xml | – sequence: 1 givenname: Taylor R. orcidid: 0000-0002-0982-3244 surname: Greif fullname: Greif, Taylor R. email: tgreif@med.umich.edu organization: University of Michigan – Michigan Medicine, Department of Psychiatry – Neuropsychology Section, 2101 Commonwealth Blvd, Ste C., Ann Arbor, MI, 48105, USA – sequence: 2 givenname: Asra surname: Askari fullname: Askari, Asra organization: University of Michigan – Michigan Medicine, Department of Neurosurgery, 1500 E. Medical Center Drive, SPC 5338, Ann Arbor, MI, 48109, USA – sequence: 3 givenname: Amanda surname: Cook Maher fullname: Cook Maher, Amanda organization: University of Michigan – Michigan Medicine, Department of Psychiatry – Neuropsychology Section, 2101 Commonwealth Blvd, Ste C., Ann Arbor, MI, 48105, USA – sequence: 4 givenname: Parag G. orcidid: 0000-0002-2300-6136 surname: Patil fullname: Patil, Parag G. organization: University of Michigan – Michigan Medicine, Department of Neurosurgery, 1500 E. Medical Center Drive, SPC 5338, Ann Arbor, MI, 48109, USA – sequence: 5 givenname: Carol surname: Persad fullname: Persad, Carol organization: University of Michigan – Michigan Medicine, Department of Psychiatry – Neuropsychology Section, 2101 Commonwealth Blvd, Ste C., Ann Arbor, MI, 48105, USA |
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Keywords | Active contact location Verbal fluency Parkinson's disease Deep Brain Stimulation |
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Snippet | Verbal fluency (VF) decline is a well-documented cognitive effect of Deep Brain Stimulation of the subthalamic nucleus (STN-DBS) in patients with Parkinson's... INTRODUCTIONVerbal fluency (VF) decline is a well-documented cognitive effect of Deep Brain Stimulation of the subthalamic nucleus (STN-DBS) in patients with... |
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SubjectTerms | Active contact location Aged Deep Brain Stimulation Deep Brain Stimulation - adverse effects Electrodes, Implanted - adverse effects Female Humans Linear Models Male Middle Aged Parkinson Disease - therapy Parkinson's disease Postoperative Complications - etiology Retrospective Studies Speech Disorders - etiology Subthalamic Nucleus - surgery Treatment Outcome Verbal fluency |
Title | Anterior lead location predicts verbal fluency decline following STN-DBS in Parkinson's disease |
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