Functional atlases for analysis of motor and neuropsychological outcomes after medial globus pallidus and subthalamic stimulation

Abstract

Anatomical atlases have been developed to improve the targeting of basal ganglia in deep brain stimulation. However, the sole anatomy cannot predict the functional outcome of this surgery. Deep brain stimulation is often a compromise between several functional outcomes: motor, fluency and neuropsychological outcomes in particular. In this study, we have developed anatomo-clinical atlases for the targeting of subthalamic and medial globus pallidus deep brain stimulation. The activated electrode coordinates of 42 patients implanted in the subthalamic nucleus and 29 patients in the medial globus pallidus were studied. The atlas was built using the representation of the volume of tissue theoretically activated by the stimulation. The UPDRS score was used to represent the motor outcome. The Stroop test was represented as well as semantic and phonemic fluencies. For the subthalamic nucleus, best motor outcomes were obtained when the supero-lateral part of the nucleus was stimulated whereas the semantic fluency was impaired in this same region. For the medial globus pallidus, best outcomes were obtained when the postero ventral part of the nucleus was stimulated whereas the phonemic fluency was impaired in this same region. There was no significant neuropsychological impairment. We have proposed new anatomo-clinical atlases to visualize the motor and neuropsychological consequences at 6 months of subthalamic nucleus and pallidal stimulation in patients with Parkinson's disease.

Fig 1. Axial, sagittal and coronal views of the ParkMedAtlis template showing the ‘Patient Atlas’ (first row), the ‘Functional Atlases’ built on UPDRS III analysis (second row) and on Stroop analysis (third row) in patients with STN DBS at 6 months postoperatively.

Amygdala (light pink), hippocampus (pink), putamen (violet), GPm (orange), internal capsule (white), lateral pallidum (green), caudate nucleus (light blue), thalami (yellow), substantia nigra (grey), STN (light orange), cerebellar tent (red), ventricles (dark blue).

Fig 2. Axial, sagittal and coronal views of the ParkMedAtlis template showing the ‘Patient Atlas’ (first row), the ‘Functional Atlases’ built on verbal fluency analysis (second row, semantic fluency and third row, phonemic fluency) in patients with STN DBS at 6 months postoperatively.

Amygdala (light pink), hippocampus (pink), putamen (violet), GPm (orange), internal capsule (white), lateral pallidum (green), caudate nucleus (light blue), thalami (yellow), substantia nigra (grey), STN (light orange), cerebellar tent (red), ventricles (dark blue).

Fig 3. Axial, sagittal and coronal views of the ParkMedAtlis template showing the ‘Patient Atlas’ (first row) and the ‘Functional Atlas’ built on UPDRS III analysis (second row) and on Stroop analysis (third row) in patients with GPm DBS at 6 months postoperatively.

Amygdala (light pink), hippocampus (pink), putamen (violet), GPm (orange), internal capsule (white), lateral pallidum (green), caudate nucleus (light blue), thalami (yellow), substantia nigra (grey), STN (light orange), cerebellar tent (red), ventricles (dark blue).

Fig 4. Axial, sagittal and coronal views of the ParkMedAtlis template showing the ‘Patients Atlas’ (first row), the ‘Functional Atlas’ built on verbal fluency analysis (second row, semantic fluency and third row, phonemic fluency) in patients with GPm DBS at 6 months postoperatively.

Amygdala (light pink), hippocampus (pink), putamen (violet), GPm (orange), internal capsule (white), lateral pallidum (green), caudate nucleus (light blue), thalami (yellow), substantia nigra (grey), STN (light orange), cerebellar tent (red), ventricles (dark blue).