Deep Brain Stimulation Modulates the Visual Pathway to Improve Freezing of Gait in Parkinson's Disease Patients

Abstract

ObjectiveTo investigate the involvement of the visual cortex in improving freezing of gait (FoG) after subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson’s disease (PD) patients using whole-brain seed-based functional connectivity. MethodsA total of 66 PD patients with FoG who underwent bilateral STN-DBS were included in our study. Patients were divided into a FoG responder group (FoG-R) and an FoG non-responder group (FoG-nonR) according to whether FoG improved one year after DBS. We compared the differences in clinical characteristics, brain structural imaging and seed-based functional connectivity between the two groups. The locations of active contacts were further analyzed. ResultsAll PD patients benefited from STN-DBS. No significant differences in the baseline characteristics or brain structures were found between the two groups. Seed-based functional connectivity analysis revealed that better connectivity in bilateral primary visual areas was associated with better clinical improvement in FoG (p < 0.05 familywise error [FWE] corrected). Further analysis revealed that this disparity was associated with the location of the active contacts within the rostral region of the sensorimotor subregion in the FoG-R group, in contrast to the findings in the FoG-nonR group. ConclusionThis study suggested that DBS in the rostral region of the STN sensorimotor subregion may alleviate FoG by strengthening functional connectivity in primary visual areas, which has significant implications for guiding surgical strategies for FoG in the future.