TY  - JOUR
A1  - Gonzalez‐Escamilla, Gabriel
A1  - Muthuraman, Muthuraman
A1  - Reich, Martin M.
A1  - Koirala, Nabin
A1  - Riedel, Christian
A1  - Glaser, Martin
A1  - Lange, Florian
A1  - Deuschl, Günther
A1  - Volkmann, Jens
A1  - Groppa, Sergiu
T1  - Cortical network fingerprints predict deep brain stimulation outcome in dystonia
JF  - Movement Disorders
N2  - Background
Deep brain stimulation (DBS) is an effective evidence‐based therapy for dystonia. However, no unequivocal predictors of therapy responses exist. We investigated whether patients optimally responding to DBS present distinct brain network organization and structural patterns.

Methods
From a German multicenter cohort of 82 dystonia patients with segmental and generalized dystonia who received DBS implantation in the globus pallidus internus, we classified patients based on the clinical response 3 years after DBS. Patients were assigned to the superior‐outcome group or moderate‐outcome group, depending on whether they had above or below 70% motor improvement, respectively. Fifty‐one patients met MRI‐quality and treatment response requirements (mean age, 51.3 ± 13.2 years; 25 female) and were included in further analysis. From preoperative MRI we assessed cortical thickness and structural covariance, which were then fed into network analysis using graph theory. We designed a support vector machine to classify subjects for the clinical response based on individual gray‐matter fingerprints.

Results
The moderate‐outcome group showed cortical atrophy mainly in the sensorimotor and visuomotor areas and disturbed network topology in these regions. The structural integrity of the cortical mantle explained about 45% of the DBS stimulation amplitude for optimal response in individual subjects. Classification analyses achieved up to 88% of accuracy using individual gray‐matter atrophy patterns to predict DBS outcomes.

Conclusions
The analysis of cortical integrity, informed by group‐level network properties, could be developed into independent predictors to identify dystonia patients who benefit from DBS.
KW  - brain networks
KW  - clinical outcome
KW  - deep brain stimulation
KW  - dystonia
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-213532
VL  - 34
IS  - 10
SP  - 1536
EP  - 1545
ER  -