Pre-operative neural substrates of deep brain stimulation outcomes: A systematic review and cross-disorder network synthesis.
Yutong Bai, Tiffany A Rodrigues, Andrew Z Yang et al.
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In 30 seconds
This systematic review and cross-disorder network synthesis examined whether pre-operative neuroimaging features are associated with deep brain stimulation (DBS) outcomes. It included 53 studies involving 1758 patients, predominantly with movement disorders, especially Parkinson’s disease, or psychiatric disorders, mainly major depressive disorder. Disease-specific frequency maps and normative connectivity analyses identified distinct central regions and circuit patterns: motor and basal ganglia networks in Parkinson’s disease, and amygdala and limbic networks in major depressive disorder. Both disorders also showed engagement of shared higher-order networks. The authors conclude that pre-operative circuit organization is associated with outcomes, while noting that proposed imaging-informed patient selection requires further validation.
Key findings
- The review included 53 studies and 1758 patients; movement disorders accounted for 73.6% and psychiatric disorders for 20.8%.
- In Parkinson’s disease, network analysis identified the primary motor cortex, left thalamus, brainstem, and right subthalamic nucleus as central regions.
- In major depressive disorder, central regions included the bilateral amygdala, middle frontal gyrus, and frontal operculum cortex.
- External networks showed basal ganglia engagement in Parkinson’s disease, limbic engagement in major depressive disorder, and shared salience, cerebellar, and default mode networks.
Why it matters
The findings frame DBS outcomes as related not only to the stimulation target but also to the broader pre-operative circuitry on which stimulation acts. This network perspective may help explain variation in surgical benefit across patients and provides a basis for investigating whether imaging can support more individualized selection, although the proposed application remains to be validated.
What to keep in mind
The synthesis relies on reported neuroimaging regions and normative connectivity analyses; the abstract states that imaging-informed patient selection requires further validation.