Background:Deep brain stimulation of the subthalamic nucleus (STN-DBS) has been reported to be effective for camptocormia in Parkinson’s disease (PD). However, the association between clinical effectiveness and the stimulated volumes or structural connectivity remains unexplored. Objective:To investigate the effectiveness of STN-DBS for treating camptocormia in PD and its association with volumes of tissue activated (VTA) and structural connectivity. Methods:We reviewed video recordings of patients who had undergone STN-DBS. The total and upper camptocormia (TCC and UCC) angles were measured to quantify changes in camptocormia. The Movement Disorders Society Unified Parkinson’s Disease Rating Scale III (MDS-UPDRS III) was used to assess motor symptoms. Pre- and postoperative brain images were collected for modeling volume of VTA and structural connectivity using Lead-DBS software. Results:Participants included 36 patients with PD (8 with TCC-camptocormia and 2 with UCC-camptocormia) treated with bilateral STN-DBS. After surgery, patients showed a significant improvement in postural alignment at follow-up (mean follow-up duration: 6.0±2.2 months). In the entire sample, higher structural connectivity to the right supplementary motor area (SMA) and right lateral premotor cortex along the dorsal plane (PMd) was associated with larger postsurgical improvements in axial signs and TCC angles after stimulation was turned on. In patients diagnosed with camptocormia, the improvement in camptocormia angles after STN-DBS was associated with a larger VTA overlap with STN (R = 0.75, p = 0.032). Conclusion:This study suggests that both VTA overlap with STN and structural connectivity to motor cortex are associated with the effectiveness of STN-DBS for managing camptocormia in PD.

中文翻译：

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丘脑底刺激治疗帕金森病中的丘脑：组织激活体积和结构连接性与临床有效性的关联

背景：据报道，丘脑底核深部脑刺激 (STN-DBS) 可有效治疗帕金森病 (PD) 中的头颅。然而，临床有效性与刺激体积或结构连通性之间的关联仍未得到探索。目的：研究 STN-DBS 治疗 PD 中垂皮的有效性及其与组织激活体积 (VTA) 和结构连接的关联。方法：我们回顾了接受 STN-DBS 的患者的视频记录。测量总的和上部的弯曲角（TCC 和 UCC）以量化弯曲角的变化。运动障碍协会统一帕金森病评定量表 III (MDS-UPDRS III) 用于评估运动症状。使用 Lead-DBS 软件收集术前和术后脑图像，用于对 VTA 的体积和结构连接进行建模。结果：参与者包括 36 名接受双侧 STN-DBS 治疗的 PD 患者（8 名 TCC-camptocormia 和 2 名 UCC-camptocormia）。手术后，患者在随访时的姿势对齐有显着改善（平均随访时间：6.0±2.2 个月）。在整个样本中，与右侧辅助运动区 (SMA) 和沿背侧平面 (PMd) 的右侧外侧运动前皮层的更高结构连接性与开启刺激后轴向体征和 TCC 角度的更大术后改善相关。在诊断为弯曲角的患者中，STN-DBS 后弯曲角的改善与更大的 VTA 与 STN 重叠相关（R = 0.75，p = 0.032）。结论：