Identifying Imaging Biomarkers of Deep Brain Stimulation Treatment Outcome in Patients with Movement Disorders

脑深部电刺激（DBS）是一种临床神经外科手术，涉及将电极植入大脑中的特定目标区域。DBS为各种疾病的症状提供了一种既定的治疗选择，包括帕金森病（PD）、原发性震颤（ET）、肌张力障碍、抽动秽语综合征、癫痫和强迫症。DBS取得巨大成功的一个临床应用领域是缓解与运动障碍相关的衰弱性运动症状。具体而言，DBS已被广泛用于治疗PD、ET和肌张力障碍患者，成为难治性帕金森病患者的主要治疗选择。关键是，DBS的术后疗效与运动症状的改善相关，存在广泛的差异，导致最佳和次佳结局。DBS的广泛变异性可能是由于多种因素，包括神经外科靶向区域、脑结构和功能的异质性、DBS刺激参数、疾病表型和疾病严重程度。DBS的变异性也严重混淆的事实，即DBS的工作原理的根本机制是不完全理解在这个当前时刻的时间。一个可能的途径正在探索揭示的变异性在术后DBS的结果是通过神经影像学。特别是磁共振成像（MRI）是一种技术，它为我们理解大脑变化与大量神经系统疾病和障碍之间的关系奠定了基础。该项目旨在利用常规收集的术前MRI来确定临床有用的新型术前生物标志物，以预测DBS疗效。特别是，该项目旨在利用各种先进的神经成像和机器学习分析技术，评估与大脑形态和结构连接差异有关的数据。来自各种运动障碍的术前患者数据将在沃尔顿中心NHS基金会信托基金和开放获取的存储库中获得。该项目对改善DBS的临床运动结果具有深远的影响。确定对治疗有最佳反应的患者将有助于未来选择DBS候选人，改善医疗保健系统内的疾病管理。了解和改善反应次优的患者的结局对于改善生活质量和告知疾病管理也至关重要。此外，识别可以证明对生物标志物预测有用的成像模式可以并入临床扫描协议中。最后，这个项目希望补充我们对DBS在不同运动障碍中的可操作性机制的理解。

Deep Brain Stimulation (DBS) is a clinical, neurosurgical procedure, involving the implantation of electrodes to specified target regions in the brain. DBS offers itself as an established treatment option for symptoms across a wide range of disorders, including Parkinson's disease (PD), Essential tremor (ET), Dystonia, Tourette Syndrome, Epilepsy and Obsessive-Compulsive Disorder. An area of clinical application where DBS has seen profound success is in the alleviation of debilitating motor symptoms associated with motor disorders. Specifically, DBS has been used extensively to treat patients with PD, ET, and Dystonia, becoming the primary therapeutic option for pharmacologically refractory patients.Crucially, there is a wide variability in the post-operative efficacy of DBS with relation to the improvement in motor symptoms, resulting in optimal and sub-optimal outcomes. Wide variability of DBS is likely due to a multitude of factors, including the neurosurgically targeted area, heterogeneity of brain structure and function, DBS stimulation parameters, disease phenotype, and disease severity. DBS variability is also critically confounded by the fact that the underlying mechanisms for exactly how DBS works are not fully understood at this current moment in time.One possible avenue being explored to shed light on the variability in post-surgical DBS outcomes is through Neuroimaging. Magnetic Resonance Imaging (MRI) in particular, is a technique that has paved our understanding of the relationship between changes in the brain and a plethora of neurological diseases and disorders. This project is specifically aimed at utilising routinely collected presurgical MRI to ascertain clinically useful, novel preoperative biomarkers to predict DBS efficacy. In particular, the project aims to assess data pertaining to differences in brain morphology and structural connectivity, utilising various advanced neuroimaging and machine learning analysis techniques. Preoperative patient data from a variety of movement disorders will be acquired at the Walton Centre NHS Foundation Trust and from open-access repositories.This project has far-reaching ramifications for improving clinical motor outcomes from DBS. Identifying patients who will be optimally responsive to treatment will aid the future selection of DBS candidates, improving disease management within health care systems. Understanding and improving outcomes for patients who respond sub-optimally is also critical to improve quality of life and inform disease management. Furthermore, identifying imaging modalities that can prove useful for biomarker prediction can be incorporated into clinical scanning protocols. Finally, this project hopes to supplement our understanding of DBS operativity mechanisms across different movement disorders.