Abstract
Pallidal deep brain stimulation (DBS) is an increasingly used therapy for Parkinson’s disease (PD). Here, we study the effect of DBS on pallidal oscillatory activity as well as on symptom severity in an individual with PD implanted with a new pulse generator (Medtronic Percept system) which facilitates chronic recording of local field potentials (LFP) through implanted DBS lead. Pallidal LFPs were recorded while delivering stimulation in a monopolar configuration using stepwise increments (0.5 mA, every 20 s). At each stimulation amplitude, the power spectral density (PSD) was computed, and beta power (13–30 Hz) was calculated and correlated with the degree of bradykinesia. Pallidal beta power was reduced when therapeutic stimulation was delivered. Beta power correlated to the severity of bradykinesia. Worsening of parkinsonism when excessive stimulation was applied was associated with a rebound in the beta band power. These preliminary results suggest that pallidal beta power might be used as an objective marker of the disease state in PD. The use of brain sensing from implanted neural interfaces may in the future facilitate clinical programming. Detection of rebound could help to optimize benefits and minimize worsening from overstimulation.
Highlights
Deep brain stimulation (DBS) is an invasive neurosurgical therapy which can be applied for select movement and neuropsychiatric disorders
A novel sensing-enabled deep brain stimulation (DBS) device was applied to an individual with Parkinson’s disease (PD) implanted with globus pallidus internus (GPi) DBS
The bradykinesia severity and rigidity were recorded at each stimulation amplitude and was correlated with the local field potentials (LFP) feature
Summary
Deep brain stimulation (DBS) is an invasive neurosurgical therapy which can be applied for select movement and neuropsychiatric disorders. The classical procedure consists of implanting electrodes in the brain and delivering continuously electrical stimulation through an implanted battery source referred to as an impulse generator. The subthalamic nucleus (STN) has been the most common brain region targeted, the globus pallidus internus (GPi) has been increasingly used especially in cases with dyskinesia, cognitive issues and a need for long-term medication adjustment flexibility (Okun et al, 2009; Follett et al, 2010). One challenge in DBS treatment has been the complexity of choosing the optimal therapeutic settings. DBS therapy can be adjusted by changing the stimulation frequency, pulse width, and amplitude which is deleivered via a standard square wave pulse.
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