Lukas Goede
@lukasgoede.bsky.social
Neuroscientist @ Brigham & Women's Hospital, Harvard Medical School | @netstim.org | Neurology resident | Interested in deep brain stimulation, non-invasive brain stimulation and movement disorders
And of course, institutions like Brigham and Women’s Hospital, Boston, and Charité - Universitätsmedizin Berlin, providing the environment that made this work possible.
May 22, 2025 at 8:55 PM
And of course, institutions like Brigham and Women’s Hospital, Boston, and Charité - Universitätsmedizin Berlin, providing the environment that made this work possible.
Projects like this are only possible thanks to strong research support.
Grateful for funding from the Thiemann Parkinson Foundation, @dfg.de, and many others who made this work possible - not just for the project, but personally for me as well.
Grateful for funding from the Thiemann Parkinson Foundation, @dfg.de, and many others who made this work possible - not just for the project, but personally for me as well.
May 22, 2025 at 8:41 PM
Projects like this are only possible thanks to strong research support.
Grateful for funding from the Thiemann Parkinson Foundation, @dfg.de, and many others who made this work possible - not just for the project, but personally for me as well.
Grateful for funding from the Thiemann Parkinson Foundation, @dfg.de, and many others who made this work possible - not just for the project, but personally for me as well.
Special thanks to @andreashorn.org and @foxmdphd.bsky.social for their mentorship at the @braincircuits.bsky.social, BWH.
This was a long-term project developed under @andreashorn.org's guidance, and I couldn’t be more grateful that it marks the conclusion of my time in Boston.
This was a long-term project developed under @andreashorn.org's guidance, and I couldn’t be more grateful that it marks the conclusion of my time in Boston.
May 22, 2025 at 8:41 PM
Special thanks to @andreashorn.org and @foxmdphd.bsky.social for their mentorship at the @braincircuits.bsky.social, BWH.
This was a long-term project developed under @andreashorn.org's guidance, and I couldn’t be more grateful that it marks the conclusion of my time in Boston.
This was a long-term project developed under @andreashorn.org's guidance, and I couldn’t be more grateful that it marks the conclusion of my time in Boston.
Thank you to patients, collaborators and coauthors who made this project possible!
To mention just a few colleagues who are here on BlueSky:
@patriciazvarova.bsky.social @bahnebahners.bsky.social @emiddlebrooksmd.bsky.social @jjoutsa.bsky.social @foxmdphd.bsky.social @andreashorn.org
@netstim.org
To mention just a few colleagues who are here on BlueSky:
@patriciazvarova.bsky.social @bahnebahners.bsky.social @emiddlebrooksmd.bsky.social @jjoutsa.bsky.social @foxmdphd.bsky.social @andreashorn.org
@netstim.org
May 22, 2025 at 8:41 PM
Thank you to patients, collaborators and coauthors who made this project possible!
To mention just a few colleagues who are here on BlueSky:
@patriciazvarova.bsky.social @bahnebahners.bsky.social @emiddlebrooksmd.bsky.social @jjoutsa.bsky.social @foxmdphd.bsky.social @andreashorn.org
@netstim.org
To mention just a few colleagues who are here on BlueSky:
@patriciazvarova.bsky.social @bahnebahners.bsky.social @emiddlebrooksmd.bsky.social @jjoutsa.bsky.social @foxmdphd.bsky.social @andreashorn.org
@netstim.org
This was a huge team effort - combining datasets across disorders, continents, and methods.
We hope this work helps advance neuromodulation toward guided, symptom-specific treatment.
Full paper: www.nature.com/articles/s41...
We hope this work helps advance neuromodulation toward guided, symptom-specific treatment.
Full paper: www.nature.com/articles/s41...
Convergent mapping of a tremor treatment network - Nature Communications
Goede et al. combined multiple modalities to define a common tremor network across disorders. This finding may help optimize deep brain stimulation and guide future noninvasive therapies.
www.nature.com
May 22, 2025 at 8:41 PM
This was a huge team effort - combining datasets across disorders, continents, and methods.
We hope this work helps advance neuromodulation toward guided, symptom-specific treatment.
Full paper: www.nature.com/articles/s41...
We hope this work helps advance neuromodulation toward guided, symptom-specific treatment.
Full paper: www.nature.com/articles/s41...
We also provide a literature overview of a key structure consistently associated with tremor improvement:
👉 the dentato-rubro-thalamic tract (DRT).
The best DBS outcomes align closely with its trajectory - regardless of target or disorder.
👉 the dentato-rubro-thalamic tract (DRT).
The best DBS outcomes align closely with its trajectory - regardless of target or disorder.
May 22, 2025 at 8:41 PM
We also provide a literature overview of a key structure consistently associated with tremor improvement:
👉 the dentato-rubro-thalamic tract (DRT).
The best DBS outcomes align closely with its trajectory - regardless of target or disorder.
👉 the dentato-rubro-thalamic tract (DRT).
The best DBS outcomes align closely with its trajectory - regardless of target or disorder.
We added extensive supplementary material, including a review on:
👉 What influences outcomes after DBS?
👉 What influences outcomes after DBS?
May 22, 2025 at 8:41 PM
We added extensive supplementary material, including a review on:
👉 What influences outcomes after DBS?
👉 What influences outcomes after DBS?
Of course, there are limitations.
We combined diverse datasets and methods - adding variability.
But this heterogeneity was deliberate, to build a more robust and generalizable network.
And while correlational analysis, the convergence of lesions, DBS, and EMG-fMRI supports causal insight.
We combined diverse datasets and methods - adding variability.
But this heterogeneity was deliberate, to build a more robust and generalizable network.
And while correlational analysis, the convergence of lesions, DBS, and EMG-fMRI supports causal insight.
May 22, 2025 at 8:41 PM
Of course, there are limitations.
We combined diverse datasets and methods - adding variability.
But this heterogeneity was deliberate, to build a more robust and generalizable network.
And while correlational analysis, the convergence of lesions, DBS, and EMG-fMRI supports causal insight.
We combined diverse datasets and methods - adding variability.
But this heterogeneity was deliberate, to build a more robust and generalizable network.
And while correlational analysis, the convergence of lesions, DBS, and EMG-fMRI supports causal insight.
So what do we take away from all this?
✅ Different forms of tremor share a common brain network
✅ DBS likely works by modulating this circuit
✅ STN, VIM, GPi may all be access points to the same network
✅ This opens the door to symptom-specific neuromodulation - both invasive and noninvasive
✅ Different forms of tremor share a common brain network
✅ DBS likely works by modulating this circuit
✅ STN, VIM, GPi may all be access points to the same network
✅ This opens the door to symptom-specific neuromodulation - both invasive and noninvasive
May 22, 2025 at 8:41 PM
So what do we take away from all this?
✅ Different forms of tremor share a common brain network
✅ DBS likely works by modulating this circuit
✅ STN, VIM, GPi may all be access points to the same network
✅ This opens the door to symptom-specific neuromodulation - both invasive and noninvasive
✅ Different forms of tremor share a common brain network
✅ DBS likely works by modulating this circuit
✅ STN, VIM, GPi may all be access points to the same network
✅ This opens the door to symptom-specific neuromodulation - both invasive and noninvasive
And yes - indeed.
Connectivity between GPi-DBS electrodes and the convergent tremor map explained significant variance in clinical outcomes.
Connectivity between GPi-DBS electrodes and the convergent tremor map explained significant variance in clinical outcomes.
May 22, 2025 at 8:41 PM
And yes - indeed.
Connectivity between GPi-DBS electrodes and the convergent tremor map explained significant variance in clinical outcomes.
Connectivity between GPi-DBS electrodes and the convergent tremor map explained significant variance in clinical outcomes.
We then integrated all maps - lesions, atrophy, fMRI, and DBS - into a multimodal tremor network map.
The key test:
Could this convergent map explain tremor outcomes in a new, independent cohort: Parkinson's disease patients with GPi-DBS?
The key test:
Could this convergent map explain tremor outcomes in a new, independent cohort: Parkinson's disease patients with GPi-DBS?
May 22, 2025 at 8:41 PM
We then integrated all maps - lesions, atrophy, fMRI, and DBS - into a multimodal tremor network map.
The key test:
Could this convergent map explain tremor outcomes in a new, independent cohort: Parkinson's disease patients with GPi-DBS?
The key test:
Could this convergent map explain tremor outcomes in a new, independent cohort: Parkinson's disease patients with GPi-DBS?
To power these analyses, we created a new, high-resolution normative connectome:
🧠 Based on resting-state fMRI from 1,087 healthy subjects (HCP), 2 mm isotropic voxels
We also replicated results using a Parkinson’s disease-specific connectome from the PPMI cohort. Findings held up across datasets.
🧠 Based on resting-state fMRI from 1,087 healthy subjects (HCP), 2 mm isotropic voxels
We also replicated results using a Parkinson’s disease-specific connectome from the PPMI cohort. Findings held up across datasets.
May 22, 2025 at 8:41 PM
To power these analyses, we created a new, high-resolution normative connectome:
🧠 Based on resting-state fMRI from 1,087 healthy subjects (HCP), 2 mm isotropic voxels
We also replicated results using a Parkinson’s disease-specific connectome from the PPMI cohort. Findings held up across datasets.
🧠 Based on resting-state fMRI from 1,087 healthy subjects (HCP), 2 mm isotropic voxels
We also replicated results using a Parkinson’s disease-specific connectome from the PPMI cohort. Findings held up across datasets.
Building on these data, we analyzed two different DBS patient cohorts:
• Parkinson’s disease patients with subthalamic DBS
• Essential tremor patients with thalamic DBS
Outcome maps from each group could explain outcomes in the other.
Disorder-independent. Target-independent.
• Parkinson’s disease patients with subthalamic DBS
• Essential tremor patients with thalamic DBS
Outcome maps from each group could explain outcomes in the other.
Disorder-independent. Target-independent.
May 22, 2025 at 8:41 PM
Building on these data, we analyzed two different DBS patient cohorts:
• Parkinson’s disease patients with subthalamic DBS
• Essential tremor patients with thalamic DBS
Outcome maps from each group could explain outcomes in the other.
Disorder-independent. Target-independent.
• Parkinson’s disease patients with subthalamic DBS
• Essential tremor patients with thalamic DBS
Outcome maps from each group could explain outcomes in the other.
Disorder-independent. Target-independent.
Another key step was to collaborate with Rick Helmich.
We incorporated a map from the well-known dimmer-switch model of tremor, based on EMG-fMRI:
🔗 academic.oup.com/brain/articl...
Once again, the same core regions emerged:
- Motor cortex
- Motor cerebellum
Three paths. One destination.
We incorporated a map from the well-known dimmer-switch model of tremor, based on EMG-fMRI:
🔗 academic.oup.com/brain/articl...
Once again, the same core regions emerged:
- Motor cortex
- Motor cerebellum
Three paths. One destination.
May 22, 2025 at 8:41 PM
Another key step was to collaborate with Rick Helmich.
We incorporated a map from the well-known dimmer-switch model of tremor, based on EMG-fMRI:
🔗 academic.oup.com/brain/articl...
Once again, the same core regions emerged:
- Motor cortex
- Motor cerebellum
Three paths. One destination.
We incorporated a map from the well-known dimmer-switch model of tremor, based on EMG-fMRI:
🔗 academic.oup.com/brain/articl...
Once again, the same core regions emerged:
- Motor cortex
- Motor cerebellum
Three paths. One destination.
Next, we included an atrophy network map from essential tremor patients, based on a recent paper by Ellen Younger et al.:
🔗 doi.org/10.1212/WNL....
This atrophy-based network pointed to cerebellar regions, adding another independent layer of support.
🔗 doi.org/10.1212/WNL....
This atrophy-based network pointed to cerebellar regions, adding another independent layer of support.
Mapping Essential Tremor to a Common Brain Network Using Functional Connectivity Analysis | Neurology
Background and ObjectivesThe cerebello-thalamo-cortical circuit plays a critical role in essential tremor (ET).
However, abnormalities have been reported in multiple brain regions outside this circuit...
doi.org
May 22, 2025 at 8:41 PM
Next, we included an atrophy network map from essential tremor patients, based on a recent paper by Ellen Younger et al.:
🔗 doi.org/10.1212/WNL....
This atrophy-based network pointed to cerebellar regions, adding another independent layer of support.
🔗 doi.org/10.1212/WNL....
This atrophy-based network pointed to cerebellar regions, adding another independent layer of support.
We found: the stronger the connection between a DBS site and this lesion-derived network, the better the tremor relief - even across different disorders.
May 22, 2025 at 8:41 PM
We found: the stronger the connection between a DBS site and this lesion-derived network, the better the tremor relief - even across different disorders.
First, we revisited stroke lesions that alleviated tremor.
As shown by @jjoutsa.bsky.social, these lesions mapped to a distinct functional network:
🔗 doi.org/10.1002/ana....
As shown by @jjoutsa.bsky.social, these lesions mapped to a distinct functional network:
🔗 doi.org/10.1002/ana....
Identifying therapeutic targets from spontaneous beneficial brain lesions
Brain damage can occasionally result in paradoxical functional benefit, which could help identify therapeutic targets for neuromodulation. However, these beneficial lesions are rare and lesions in mu...
doi.org
May 22, 2025 at 8:41 PM
First, we revisited stroke lesions that alleviated tremor.
As shown by @jjoutsa.bsky.social, these lesions mapped to a distinct functional network:
🔗 doi.org/10.1002/ana....
As shown by @jjoutsa.bsky.social, these lesions mapped to a distinct functional network:
🔗 doi.org/10.1002/ana....
We asked a simple question:
Does a shared tremor treatment network exist across diseases and deep brain stimulation (DBS) targets?
To find out, we combined four independent modalities:
🧠 Lesions
🧠 Atrophy
🧠 EMG-fMRI
🧠 DBS outcomes
Does a shared tremor treatment network exist across diseases and deep brain stimulation (DBS) targets?
To find out, we combined four independent modalities:
🧠 Lesions
🧠 Atrophy
🧠 EMG-fMRI
🧠 DBS outcomes
May 22, 2025 at 8:41 PM
We asked a simple question:
Does a shared tremor treatment network exist across diseases and deep brain stimulation (DBS) targets?
To find out, we combined four independent modalities:
🧠 Lesions
🧠 Atrophy
🧠 EMG-fMRI
🧠 DBS outcomes
Does a shared tremor treatment network exist across diseases and deep brain stimulation (DBS) targets?
To find out, we combined four independent modalities:
🧠 Lesions
🧠 Atrophy
🧠 EMG-fMRI
🧠 DBS outcomes
Big thanks to @patriciazvarova.bsky.social and @bahnebahners.bsky.social for their wonderful contributions, and to @andreashorn.org for his mentorship on this project!
Read the full study here:
onlinelibrary.wiley.com/doi/10.1002/...
Read the full study here:
onlinelibrary.wiley.com/doi/10.1002/...
Patient Selection in Deep Brain Stimulation: A Role for Transcranial Direct Current Stimulation to Enhance the Levodopa Challenge?
Dopaminergic medication and deep brain stimulation (DBS) improve motor symptoms in Parkinson's disease (PD), but levodopa response alone may not predict DBS outcomes. We retrospectively analyzed 19 P....
onlinelibrary.wiley.com
May 19, 2025 at 7:14 PM
Big thanks to @patriciazvarova.bsky.social and @bahnebahners.bsky.social for their wonderful contributions, and to @andreashorn.org for his mentorship on this project!
Read the full study here:
onlinelibrary.wiley.com/doi/10.1002/...
Read the full study here:
onlinelibrary.wiley.com/doi/10.1002/...
Of course: this is a small sample and an exploratory analysis.
But this cohort is rare: patients who received all three interventions: tDCS, levodopa challenge, and DBS.
That makes these findings hypothesis-generating and worth building on.
But this cohort is rare: patients who received all three interventions: tDCS, levodopa challenge, and DBS.
That makes these findings hypothesis-generating and worth building on.
May 19, 2025 at 7:14 PM
Of course: this is a small sample and an exploratory analysis.
But this cohort is rare: patients who received all three interventions: tDCS, levodopa challenge, and DBS.
That makes these findings hypothesis-generating and worth building on.
But this cohort is rare: patients who received all three interventions: tDCS, levodopa challenge, and DBS.
That makes these findings hypothesis-generating and worth building on.
Here’s the interesting part:
When we combined both tDCS and levodopa responses in a linear model, they jointly explained a significant amount of the variance in DBS outcomes.
When we combined both tDCS and levodopa responses in a linear model, they jointly explained a significant amount of the variance in DBS outcomes.
May 19, 2025 at 7:14 PM
Here’s the interesting part:
When we combined both tDCS and levodopa responses in a linear model, they jointly explained a significant amount of the variance in DBS outcomes.
When we combined both tDCS and levodopa responses in a linear model, they jointly explained a significant amount of the variance in DBS outcomes.
So we asked, in our cohort:
(i) Does the levodopa response predict DBS outcome?
(ii) Does it correlate with the tDCS response?
The trends were there - but in this small sample (N = 10), neither reached significance on its own.
(i) Does the levodopa response predict DBS outcome?
(ii) Does it correlate with the tDCS response?
The trends were there - but in this small sample (N = 10), neither reached significance on its own.
May 19, 2025 at 7:14 PM
So we asked, in our cohort:
(i) Does the levodopa response predict DBS outcome?
(ii) Does it correlate with the tDCS response?
The trends were there - but in this small sample (N = 10), neither reached significance on its own.
(i) Does the levodopa response predict DBS outcome?
(ii) Does it correlate with the tDCS response?
The trends were there - but in this small sample (N = 10), neither reached significance on its own.