A Canonical Neural Map and Its Deviations Shape Parkinson’s Disease Phenotypes

Parkinson’s disease (PD) presents a paradox: patients exhibit generally highly stereotyped network oscillations (excessive beta activity) yet patients manifest profound clinical heterogeneity and the literature is still sometimes inconsistent about the clinical significance of beta oscillations in PD. We resolve this discrepancy using multisite intracranial human recordings from the motor cortex and basal ganglia to define a robust, disease-specific "canonical spatio-spectral map" of network dysfunction. Crucially, we demonstrate that clinical variability is not random but is encoded by systematic, patient-specific deviations from this common template. The spatial regions exhibiting the highest inter-individual physiological variance specifically predict motor symptom severity, and data-driven clustering of these features reveals distinct clinical phenotypes. This framework establishes that individual deviations from a normative pathological map, often treated as noise, actually correlate with clinical symptoms. We provide a unified model of PD pathophysiology, linking the canonical beta signature to individual phenotypic diversity, and offer a quantitative blueprint for the development of personalized, circuit-specific therapeutic strategies.