The scientists here assessed the topography of focused ultrasound subthalamotomy by voxel-based lesion-symptom mapping to identify statistically validated brain voxels with the optimal effect against each cardinal feature and their respective cortical connectivity patterns by diffusion-weighted tractography. Bradykinesia and rigidity amelioration were associated with ablation of the rostral motor STN subregion connected to the supplementary motor and premotor cortices, whereas antitremor effect was explained by lesioning the posterolateral STN projection to the primary motor cortex. These findings were corroborated prospectively in another Parkinson disease cohort. This work concurs with recent deep brain stimulation findings that suggest different corticosubthalamic circuits underlying each Parkinson disease cardinal feature.
