Cortical network fingerprints predict deep brain stimulation outcome in dystonia

Mov Disord. 2019 Oct;34(10):1537-1546. doi: 10.1002/mds.27808. Epub 2019 Aug 21.


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. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Keywords: brain networks; clinical outcome; deep brain stimulation; dystonia.

MeSH terms

  • Adult
  • Cohort Studies
  • Deep Brain Stimulation* / methods
  • Dystonia / etiology
  • Dystonia / therapy*
  • Dystonic Disorders / therapy*
  • Female
  • Globus Pallidus / physiology
  • Globus Pallidus / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Severity of Illness Index