Clinical neurophysiological interrogation of motor slowing: A critical step towards tuning adaptive deep brain stimulation

Journal article

OBJECTIVE: Subthalamic nucleus (STN) beta activity (13-30 Hz) is the most accepted biomarker for adaptive deep brain stimulation (aDBS) for Parkinson's disease (PD). We hypothesize that different frequencies within the beta range may exhibit distinct temporal dynamics and, as a consequence, different relationships to motor slowing and adaptive stimulation patterns. We aim to highlight the need for an objective method to determine the aDBS feedback signal. METHODS: STN LFPs were recorded in 15 PD patients at rest and while performing a cued motor task. The impact of beta bursts on motor performance was assessed for different beta candidate frequencies: the individual frequency strongest associated with motor slowing, the individual beta peak frequency, the frequency most modulated by movement execution, as well as the entire-, low- and high beta band. How these candidate frequencies differed in their bursting dynamics and theoretical aDBS stimulation patterns was further investigated. RESULTS: The individual motor slowing frequency often differs from the individual beta peak or beta-related movement-modulation frequency. Minimal deviations from a selected target frequency as feedback signal for aDBS leads to a substantial drop in the burst overlapping and in the alignment of the theoretical onset of stimulation triggers (to ∼ 75% for 1 Hz, to ∼ 40% for 3 Hz deviation). CONCLUSIONS: Clinical-temporal dynamics within the beta frequency range are highly diverse and deviating from a reference biomarker frequency can result in altered adaptive stimulation patterns. SIGNIFICANCE: A clinical-neurophysiological interrogation could be helpful to determine the patient-specific feedback signal for aDBS

Authors: Alva, L; Bernasconi, E; Torrecillos, F; Fischer, P; Averna, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: Clinical Neurophysiology
• Volume: 152
• Pages: 43-56
• Publication date: 2023-05-16
• DOI: 10.1016/j.clinph.2023.04.013
• EISSN: 1872-8952
• ISSN: 1388-2457
• Language: English
• Keywords: Electroencephalography; Neurophysiology; Stimulation; Deep brain stimulation; BETA (programming language); Psychology; Neuroscience; Disease; Medicine; Beta Rhythm; Subthalamic nucleus; Internal medicine; Brain stimulation; Parkinson's disease; Bursting; Computer science