Use of Functional MRI in Deep Brain Stimulation in Parkinson's Diseases: A Systematic Review

Abstract

Deep brain stimulation (DBS) has been used to modulate aberrant circuits associated with Parkinson's disease (PD) for decades and has shown robust therapeutic benefits. However, the mechanism of action of DBS remains incompletely understood. With technological advances, there is an emerging use of functional magnetic resonance imaging (fMRI) after DBS implantation to explore the effects of stimulation on brain networks in PD. This systematic review was designed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to summarize peer-reviewed articles published within the past 10 years in which fMRI was employed on patients with PD-DBS. Search in PubMed database provided 353 references, and screenings resulted in a total of 19 studies for qualitative synthesis regarding study designs (fMRI scan timepoints and paradigm), methodology, and PD subtypes. This review concluded that fMRI may be used in patients with PD-DBS after proper safety test; resting-state and block-based fMRI designs have been employed to explore the effects of DBS on brain networks and the mechanism of action of the DBS, respectively. With further validation of safety use of fMRI and advances in imaging techniques, fMRI may play an increasingly important role in better understanding of the mechanism of stimulation as well as in improving clinical care to provide subject-specific neuromodulation treatments.

Directional electrodes in deep brain stimulation: Results of a survey by the European Association of Neurosurgical Societies (EANS)

“…However, there is also potential for novel research applications, as an overlap with the management of (complex) epilepsy disorders using a sensing closed-loop stimulation system is being recognized. Implementation of advanced tractography, analysis of continuously recorded electrophysiological variations, and ultimately fusing the data with high resolution anatomical novel scans (such as Fast Gray Matter Acquisition T1 Inversion Recovery, FGATIR) are expected to yield a better understanding of brain connectivity and function, possibly improving therapeutic outcomes ( Miao et al, 2022 ; Gadot et al, 2023 ). The major request for closed-loop stimulation is being explored but is not yet a feasible option in clinical practice.…”

Hypo-connectivity of the primary somatosensory cortex in Parkinson’s disease: a resting-state functional MRI study

“…Recent advancements indicate that somatosensory deficits in PD patients may be attributed to dopaminergic denervation associated with the disease, leading to the transmission of more distorted and less distinct information to cortical regions ( 19 ). Spontaneous pain ( 20 ), sensory disturbances ( 19 ), and the modulation by deep brain stimulation (DBS) ( 21 ) have been associated with changes of PD in resting (or intrinsic) functional connectivity. Prior research has not comprehensively examined the primary somatosensory cortex (S1), where atypical spatial and temporal processing of sensory information could lead to the generation of inaccurate signals for the planning and implementation of voluntary movement.…”

Resting State Network alterations during Deep Brain Stimulation in Parkinson’s Disease

“…However, due to difficulties in recording fMRI or M/EEG with implanted DBS, whole-brain network effects and RSNs have not been studied. The use of fMRI raises safety concerns such as lead displacement, thermal lesioning, and DBS malfunction (Albaugh and Shih, 2014; Miao et al, 2022). Moreover, its low temporal resolution and susceptibility to the artefacts caused by DBS hardware (Boutet et al, 2019) makes it a suboptimal option.…”