What question did this study set out to answer?

To explore the relationship between structural connectivity and treatment outcomes in focal dystonia via GPi-DBS.

January 20, 2026Movement Disorders Clinical Practice0 citationsOpen Access

Deep Brain Stimulation of the Internal Pallidum Modulates the Mesencephalic Locomotor Pathway in Improved Cervical Dystonic Patients

GPG PoulenSurgimab (France)NTNicolas TempierCentre National de la Recherche Scientifique GTGizem TemizCentre National de la Recherche Scientifique

Key Points

To explore the relationship between structural connectivity and treatment outcomes in focal dystonia via GPi-DBS.
Retrospective analysis of 21 focal dystonia patients undergoing GPi-DBS.
Assessment of dystonia severity before and after surgery.
Modeling of volumes of tissue activated using probabilistic tractography to analyze structural connectivity.
Mean improvement of 48.2% in TWSTRS scores post-surgery (p = 0.0003).
Mean improvement of 26.7% in BFMDRS scores, not statistically significant (p = 0.068).
VTA-MLR connectivity positively correlated with TWSTRS improvement (p = 0.048).
No significant correlation found for VTA-thalamic connectivity (p > 0.30).

Abstract

Abstract Background Deep brain stimulation of the internal globus‐pallidus (GPi‐DBS) improves focal dystonia, often incompletely. GPi‐DBS modulates pallido‐thalamo‐cortical pathways; however, involvement of descending pathways, including the mesencephalic locomotor region (MLR), has been proposed. Objectives To investigate structural connectivity for predicting outcomes. Methods We retrospectively analyzed 21 focal dystonia patients with GPi‐DBS. Dystonia was assessed pre‐ and postoperatively. Contacts were localized, volumes of tissue activated (VTA) modeled, and structural connectivity quantified using probabilistic tractography and each patient's VTA to filter a normative connectome from two healthy cohorts. Results GPi‐DBS induced mean improvement of 48.2% (SD 37.4%) in TWSTRS ( p = 0.0003) and 26.7% (SD 63.4%) in BFMDRS ( p = 0.068) in cervical dystonia patients. The sweet‐spot was within sensorimotor GPi. For the 15 cervical dystonia patients, VTA‐MLR connectivity positively correlated with TWSTRS improvement ( p = 0.048), with no significant VTA‐thalamic connectivity association ( p > 0.30). Conclusions Cervical dystonia improvement depends on the GPi‐MLR pathway, supporting tractography to optimize DBS efficacy.

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