Abstract
BackgroundPositive clinical outcomes are now well established for deep brain stimulation, but little is known about the effects of long-term deep brain stimulation on brain structural and functional connectivity. Here, we used the rare opportunity to acquire pre- and postoperative diffusion tensor imaging in a patient undergoing deep brain stimulation in bilateral subthalamic nuclei for Parkinson’s Disease. This allowed us to analyse the differences in structural connectivity before and after deep brain stimulation. Further, a computational model of spontaneous brain activity was used to estimate the changes in functional connectivity arising from the specific changes in structural connectivity.ResultsWe found significant localised structural changes as a result of long-term deep brain stimulation. These changes were found in sensory-motor, prefrontal/limbic, and olfactory brain regions which are known to be affected in Parkinson’s Disease. The nature of these changes was an increase of nodal efficiency in most areas and a decrease of nodal efficiency in the precentral sensory-motor area. Importantly, the computational model clearly shows the impact of deep brain stimulation-induced structural alterations on functional brain changes, which is to shift the neural dynamics back towards a healthy regime. The results demonstrate that deep brain stimulation in Parkinson’s Disease leads to a topological reorganisation towards healthy bifurcation of the functional networks measured in controls, which suggests a potential neural mechanism for the alleviation of symptoms.ConclusionsThe findings suggest that long-term deep brain stimulation has not only restorative effects on the structural connectivity, but also affects the functional connectivity at a global level. Overall, our results support causal changes in human neural plasticity after long-term deep brain stimulation and may help to identify the underlying mechanisms of deep brain stimulation.
Highlights
Deep brain stimulation (DBS) is a neurosurgical procedure that is increasingly used to alleviate the symptoms of a number of otherwise intractable disorders including Parkinson’s Disease (PD), essential tremor, dystonia and chronic pain [1,2]
The current study describes the case of a patient with PD undergoing bilateral subthalamic nucleus (STN) DBS surgery
We compared the simulated BOLD functional connectivity obtained with the different connectomes with a typical FC from healthy controls [21], We found that, despite the shift of the bifurcation occurring in PD, the dynamics exhibits homeostasis, i.e. the optimal fit with the empirical data was always found just below the bifurcation threshold, independently of the structural connectome considered
Summary
Deep brain stimulation (DBS) is a neurosurgical procedure that is increasingly used to alleviate the symptoms of a number of otherwise intractable disorders including Parkinson’s Disease (PD), essential tremor, dystonia and chronic pain [1,2]. DBS for PD has become well established since the 1990s with two main surgical targets, namely the subthalamic nucleus (STN) and the globus pallidus internal (GPi) [3,4,5,6] Another target in the pedunculopontine nucleus (PPN) has shown promise [7]. We used the rare opportunity to acquire pre- and postoperative diffusion tensor imaging in a patient undergoing deep brain stimulation in bilateral subthalamic nuclei for Parkinson’s Disease. This allowed us to analyse the differences in structural connectivity before and after deep brain stimulation. A computational model of spontaneous brain activity was used to estimate the changes in functional connectivity arising from the specific changes in structural connectivity
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