Brain Topography

, Volume 31, Issue 2, pp 311–321 | Cite as

Frontal Lobe Connectivity and Network Community Characteristics are Associated with the Outcome of Subthalamic Nucleus Deep Brain Stimulation in Patients with Parkinson’s Disease

  • Nabin Koirala
  • Vinzenz Fleischer
  • Martin Glaser
  • Kirsten E. Zeuner
  • Günther Deuschl
  • Jens Volkmann
  • Muthuraman Muthuraman
  • Sergiu Groppa
Original Paper


Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is nowadays an evidence-based state of the art therapy option for motor and non-motor symptoms in patients with Parkinson’s disease (PD). However, the exact anatomical regions of the cerebral network that are targeted by STN–DBS have not been precisely described and no definitive pre-intervention predictors of the clinical response exist. In this study, we test the hypothesis that the clinical effectiveness of STN–DBS depends on the connectivity profile of the targeted brain networks. Therefore, we used diffusion-weighted imaging (DWI) and probabilistic tractography to reconstruct the anatomical networks and the graph theoretical framework to quantify the connectivity profile. DWI was obtained pre-operatively from 15 PD patients who underwent DBS (mean age = 67.87 ± 7.88, 11 males, H&Y score = 3.5 ± 0.8) using a 3T MRI scanner (Philips Achieva). The pre-operative connectivity properties of a network encompassing frontal, prefrontal cortex and cingulate gyrus were directly linked to the postoperative clinical outcome. Eccentricity as a topological-characteristic of the network defining how cerebral regions are embedded in relation to distant sites correlated inversely with the applied voltage at the active electrode for optimal clinical response. We found that network topology and pre-operative connectivity patterns have direct influence on the clinical response to DBS and may serve as important and independent predictors of the postoperative clinical outcome.


Parkinson’s disease Deep brain stimulation Structural connectivity Community structures Network analysis 



Automated anatomical labeling


Area under the curve


Brain connectivity toolbox


Center of gravity


Deep brain stimulation


Diffusion-weighted imaging


Full width at half maximum

H & Y

Hoehn and Yahr


Medication off/on


Magnetization-prepared rapid gradient-echo


Receiver operating characteristic


Region of interest


Supplementary motor area


Subthalamic nucleus


Unified Parkinson’s disease rating scale


Volume of tissue activation



This work was supported by the German Research Foundation (DFG; CRC-TR-128).


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Nabin Koirala
    • 1
  • Vinzenz Fleischer
    • 1
  • Martin Glaser
    • 2
  • Kirsten E. Zeuner
    • 3
  • Günther Deuschl
    • 3
  • Jens Volkmann
    • 4
  • Muthuraman Muthuraman
    • 1
  • Sergiu Groppa
    • 1
  1. 1.Department of NeurologyJohannes Gutenberg UniversityMainzGermany
  2. 2.Department of NeurosurgeryJohannes Gutenberg UniversityMainzGermany
  3. 3.Department of NeurologyUniversity of KielKielGermany
  4. 4.Department of NeurologyUniversity of WürzburgWürzburgGermany

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