A Comprehensive Review of Brain Connectomics and Imaging to Improve Deep Brain Stimulation Outcomes

Abstract

DBS is an effective neuromodulatory therapy that has been applied in various conditions, including PD, essential tremor, dystonia, Tourette syndrome, and other movement disorders. There have also been recent examples of applications in epilepsy, chronic pain, and neuropsychiatric conditions. Innovations in neuroimaging technology have been driving connectomics, an emerging whole-brain network approach to neuroscience. Two rising techniques are functional connectivity profiling and structural connectivity profiling. Functional connectivity profiling explores the operational relationships between multiple regions of the brain with respect to time and stimuli. Structural connectivity profiling approximates physical connections between different brain regions through reconstruction of axonal fibers. Through these techniques, complex relationships can be described in various disease states, such as PD, as well as in response to therapy, such as DBS. These advances have expanded our understanding of human brain function and have provided a partial in vivo glimpse into the underlying brain circuits underpinning movement and other disorders. This comprehensive review will highlight the contemporary concepts in brain connectivity as applied to DBS, as well as introduce emerging considerations in movement disorders. © 2020 International Parkinson and Movement Disorder Society.

Keywords: connectivity profile; connectomics; deep brain stimulation; functional connectivity; structural connectivity.

FIG. 1.

Modern DBS. The current approaches to DBS are illustrated from left to right: structural connectivity profiling, functional connectivity profiling, probabilistic stimulation atlases, and volume of tissue activation analyses. Images were rendered using the Lead-DBS advanced processing pipeline and DSI Studio.^,,

FIG. 2.

Intersection of connectomics and DBS for movement disorders. Landmark articles that highlight the adoption of network-based models in DBS research.

FIG. 3.

Application of structural and functional connectivity in DBS. DBS analysis begins with postoperative imaging (A) and lead localization (B). Neuroimaging techniques can then be used to compute patient-specific structural (C) and functional (D) connectivity. These data can be combined with clinical outcome data to create statistical brain-mapping images (E) to guide DBS optimization strategies. Images were rendered using the Lead-DBS advanced processing pipeline and DSI Studio.^,,