Functional and Structural Connectivity Patterns Associated with Clinical Outcomes in Deep Brain Stimulation of the Globus Pallidus Internus for Generalized Dystonia

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Fig 1.
Axial (A), posterior oblique (B), and coronal (C) views of the position of the active contacts for all subjects relative to the globus pallidus internus (green). Contacts for nonresponders (≤25% improvement) are shown as red and responders as blue. All active contacts are nonlinearly mirrored to the same side. D, Normalized volume of tissue activated overlapping the globus pallidus internus and the Unified Dystonia Rating Scale improvement shows no significant correlation (r² = 0.05; P = .4).
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Fig 2.
Heat maps showing spatial correlation of volumes of tissue activated positively (red) and negatively (blue) correlated with improvement in the Unified Dystonia Rating Scale score.
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Fig 3.
(A) Group-level structural connectivity (DTI) results showing cortical connections positively (red) and negatively (blue) correlated with improvement in the UDRS score. Resting-state functional connectivity results show cortical (B), subcortical (C), and cerebellar (D) connectivity profiles correlated with improvement in the UDRS score.

Table 1:

Demographic, clinical, and deep brain stimulation information for the patient group

Characteristic		DBS Programming Information
Characteristic		Left		Right
Age at surgery (yr)	42.9 (7–83)	Frequency (Hz)	105.8 (±45.1)	Frequency (Hz)	108.1 (±45.5)
Sex (M/F)	21:18	Pulse width (μs)	216.9 (±99.4)	Pulse width (μs)	219.8 (±110.9)
Age of onset (yr)	31.1 (2–65)	Voltage (V)	2.9 (±0.7)	Voltage (V)	2.8 (±0.6)
Disease duration before DBS (yr)	14.3 (±14.0)	Impedance (Ω; n = 35)	1066.6 (±355.0)	Impedance (Ω; n = 35)	1129.5 (±532.6)
Follow-up period after DBS (mo)	13.4 (±6.6)	No. (%) leads in bipolar mode^{^a}	17 (43.6%)	No. (%) leads in bipolar mode^{^a}	19 (48.7%)
Positive for DYT1 mutation	9	No. (%) leads in bipolar mode^{^a}		No. (%) leads in bipolar mode^{^a}
Baseline UDRS	33 (±23.3)
Postoperative UDRS	14.6 (±15)
UDRS improvement (%)	53.2% (±34.5%)
Nonresponders (No.) (%) ≤25% improvement	7 (17.9%)

Table 2:

Comparison of stereotactic coordinates from prior studies reporting maximum anti-dystonic effect