Towards symptom-specific targeting for subthalamic deep brain stimulation in patients with Parkinson's Disease

Motivation: Variable outcomes in subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson's disease suggest a need to define symptom-specific optimal stimulation sites. Goal(s): Determine STN region and cortico-subthalamic connectivity profile for each motor symptom. Approach: 30 PD patients underwent 3T MRI and intraoperative testing using simplified UPDRS. 522 STN stimulation sites were evaluated. A cohort template was created to localize and compare STN sites. Volumes of tissue activated were modeled for individual cortico-STN connectivity analysis. Results: Three STN regions were identified: ventral for akinesia, dorsal for rigidity, and posterior for tremor. Despite individual variability, increased prefrontal connectivity was negatively correlated with akinesia improvement. Impact: These findings underscore STN heterogeneity, highlighting symptom-specific DBS targeting to enhance motor outcomes in Parkinson's disease. Emphasizing individualized targeting strategies addresses patient variability, optimizing therapy, minimizing side effects, and prompting further exploration into personalized DBS for improved symptom management.