Selection of Optimal Programming Contacts Based on Local Field Potential Recordings From Subthalamic Nucleus in Patients With Parkinson's Disease

Abstract

In the United States, the most commonly used surgical treatment for patients with Parkinson's disease is the implantation of deep brain stimulation (DBS) electrodes within the subthalamic nucleus. However, DBS device programming remains difficult and is a possible source of decreased efficacy. We investigated the relationship between local field potential (LFP) activities in the subthalamic nucleus and the therapeutic response to programming. We recorded LFPs with macroelectrodes placed unilaterally for DBS in 4 PD patients, 3 weeks after implantation, before the start of log-term DBS. Power-frequency spectra were calculated for each of 7 possible electrode contacts or contact pairs, over multiple 5- to 10-minute quiet waking epochs and over 30-second epochs during hand movements. Subsequently, DBS devices were programmed, with testing to determine which electrode contacts or contact pairs demonstrated optimal therapeutic efficacy. For each patient, the contact pair found to provide optimal efficacy was associated with the highest energy in the beta (13-32 Hz) and gamma (48-220 Hz) bands during postoperative LFP recordings at rest and during hand movements. Activities in other frequency bands did not show significant correlations between LFP power and optimal electrode contacts. Postoperative subband analysis of LFP recordings in beta and gamma frequency ranges may be used to select optimal electrode contacts. These results indicate that LFP recordings from implanted DBS electrodes can provide important clues to guide the optimization of DBS therapy in individual patients.