Functional connectivity between red nucleus and putamen predicts clinlcal response of STN-DBS

Abstract Background:While deep brain stimulation (DBS) of subthalamic nucleus (STN) is proved effective in managing motor symptoms of Parkinson's disease, it has substantial individulized variability of clinlcal responses. Prediction of treatment outcomes is therefore beneficial for surgical planning. This study aims to examine the capability of preoperative resting state brain connectivity as a potential tool to predict the clinlcal response of STN-DBS. Method: We collected the preoperative resting state functional Magnetic Resonance Imaging (MRI) of 41 participants who received DBS in the STN. The subcortical connectivity networks were estimated and correlated with postoperative exercise results. Linear regression was further used to predict the surgical improvements. Results: Functional Connectivity (FC) between subcortical nuclei of interest and DBS response showed that FC from bilateral red nuclei to putamen was related to the overall changes of UPDRS-III (left: r = -0.44 p = 0.0056, right r = -0.46 p = 0.0029, p < 0.05 after FDR correction). Additionally, FC can predict the changes of UPDRS III at 1 year after DBS (r = 0.5 p = 0.0011 error rate = 0.175 ). Cloclusions: The increased connectivity of the red nuclei in patients with Parkinson's disease may be a compensatory response to central nervous system damage. Functional MRI studies support the long-standing view that relatively intact cerebellar circuits can compensate for impaired basal ganglia function. Neuroplasticity is an adaptive mechanism that compensates for loss of function or maximizes residual function, leading to changes in brain function and morphology. This compensatory brain plasticity may be the reason why DBS improves the motor symptoms of Parkinson's disease.