AI Networking Cookbook: Practical recipes for AI-assisted network automation and development
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BACKGROUND Interindividual variability in motor outcomes after subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD) remains incompletely understood. Glymphatic-related imaging abnormalities have been reported in PD, but their relevance to neuromodulation response is unclear. OBJECTIVES To investigate whether preoperative glymphatic function, assessed using the Diffusion Tensor Imaging along the Perivascular Space (DTI-ALPS) index, is associated with motor outcomes after STN-DBS and whether hemispheric asymmetry provides additional explanatory value. METHODS We retrospectively evaluated 74 advanced PD patients undergoing bilateral STN-DBS with ≥6 months follow-up. Preoperative assessment included 3 T MRI-derived ALPS measures, Fazekas score, perivascular space burden, MDS-UPDRS-III, levodopa responsiveness, and metabolic markers. Primary outcome was percentage motor improvement at follow-up. Multivariable regression models assessed ALPS associations after adjustment for levodopa responsiveness and measured clinical covariates. RESULTS Lower ALPS asymmetry index (AI) was independently associated with greater percentage motor improvement (standardized β = -0.508, p < 0.001), while greater preoperative levodopa responsiveness was also associated with improvement (β = 0.740, p < 0.001). Lower ALPS-AI was additionally associated with axial motor improvement and responder status at both ≥50% and ≥ 33% thresholds. All four principal levodopa-adjusted ALPS-AI associations remained significant after Benjamini-Hochberg correction (all pFDR≤0.0069). Mean ALPS index, Fazekas score, and perivascular space burden were not associated with motor outcomes. CONCLUSIONS Preoperative glymphatic asymmetry was associated with motor outcomes after STN-DBS independently of levodopa responsiveness and measured clinical covariates. ALPS-derived asymmetry may capture outcome variability not reflected by conventional imaging, although prospective validation and evaluation alongside lead localization, stimulation parameters, and programming factors are required.
INTRODUCTION Subthalamic nucleus deep brain stimulation (STN-DBS) is an established treatment for advanced Parkinson's disease (PD). While traditionally reserved for later stages, growing evidence suggests earlier intervention may offer benefits. This study compares outcomes of very-early versus early DBS in a single-center cohort. METHODS This retrospective study included 65 PD patients undergoing STN-DBS (2015-2025), grouped as very-early (<5 years disease duration, n=32) or early (≥5 years, n=33). Groups were comparable in age, sex, and disease severity. Results included Hoehn & Yahr (H&Y), Unified Parkinson's Disease Rating Scale pt III (UPDRS-III), Mini Mental State Examination (MMSE), and levodopa equivalent daily dose (LEDD) assessed preoperatively, early postoperatively, and at 3 years. RESULTS Mean age was 62.45 ± 8.79 years; 69.2% were male. Both groups showed significant postoperative improvement in H&Y (p<0.001), with partial decline at 3 years, though still better than baseline. No significant group-time interaction was observed for H&Y or UPDRS-III, indicating similar long-term motor outcomes. The group-by-time interaction for LEDD was significant (p=0.002), reflecting different medication trajectories: both groups converged to similar postoperative LEDD levels despite the early DBS group starting from a substantially higher baseline (1010±514 vs 676±394mg/day; p=0.005). Multivariable regression showed that baseline preoperative LEDD was the dominant predictor of postoperative medication reduction; after adjustment, surgical timing was no longer significantly associated with LEDD reduction (p=0.622). Very-early DBS patients had lower early postoperative H&Y scores (p=0.022). Six patients were reclassified as PD-plus during follow-up; sensitivity analyses yielded consistent results. CONCLUSION Both very-early and early STN-DBS provide significant short-term motor benefits, though some decline occurs over time. Very-early DBS was associated with greater postoperative medication reduction and more favorable early functional outcomes, while long-term motor outcomes remained comparable between groups. However, differences in baseline medication burden may have contributed to the observed LEDD reduction patterns.
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