Shared pathway-specific network mechanisms of dopamine and deep brain stimulation for the treatment of Parkinson's disease

Deep brain stimulation (DBS) is a brain circuit intervention that can modulate distinct neural pathways for the alleviation of neurological symptoms in patients with brain disorders. In Parkinson's disease, subthalamic DBS clinically mimics the effect of dopaminergic drug treatment, but the shared pathway mechanisms on cortex-basal ganglia networks are unknown. To address this critical knowledge gap, we combined fully-invasive neural multisite recordings in patients undergoing DBS surgery with MRI-based whole-brain connectomics. Our findings demonstrate that dopamine and DBS exert distinct mesoscale effects through modulation of local neural population synchrony. In contrast, at the macroscale, DBS mimics dopamine in its suppression of excessive interregional network synchrony associated with indirect and hyperdirect cortex-basal ganglia pathways. Our results provide a better understanding of the circuit mechanisms of dopamine and DBS, laying the foundation for advanced closed-loop neurostimulation therapies. ### Competing Interest Statement A.A.K. reports personal fees from Medtronic and Boston Scientific. G.-H.S. reports personal fees from Medtronic, Boston Scientific, and Abbott. W.-J.N. serves as consultant to InBrain and reports personal fees from Medtronic.