Abstract
IntroductionAdaptive deep brain stimulation (aDBS) has been applied in Parkinson's disease (PD), based on the presence of brief high-amplitude beta (13–35 Hz) oscillation bursts in the subthalamic nucleus (STN), which correlate with symptom severity. Analogously, average low-frequency (LF) oscillatory power (4–12 Hz) in the internal globus pallidus (GPi) correlates with dystonic symptoms and might be a suitable physiomarker for aDBS in dystonia. Characterization of pallidal bursts could facilitate the implementation of aDBS in the GPi of PD and dystonia patients. Objective and methodsWe aimed to describe the bursting behaviour of LF and beta oscillations in a cohort of five GPi-DBS PD patients and compare their amplitude and length with those of a cohort of seven GPi-DBS dystonia, and six STN-DBS PD patients (n electrodes = 34). Furthermore, we used the information obtained to set up aDBS and test it in the GPi of both a dystonia and a PD patient (n = 2), using either LF (dystonia) or beta oscillations (PD) as feedback signals. ResultsLF and beta oscillations in the dystonic and parkinsonian GPi occur as phasic, short-lived bursts, similarly to the parkinsonian STN. The amplitude profile of such bursts, however, differed significantly. Dystonia showed higher LF burst amplitudes, while PD presented higher beta burst amplitudes. Burst characteristics in the parkinsonian GPi and STN were similar. Furthermore, aDBS applied in the GPi was feasible and well tolerated in both diseases. ConclusionPallidal LF and beta burst amplitudes have different characteristics in PD and dystonia. The presence of increased burst amplitudes could be employed as feedback for GPi-aDBS.
Highlights
Adaptive deep brain stimulation has been applied in Parkinson's disease (PD), based on the presence of brief high-amplitude beta (13–35 Hz) oscillation bursts in the subthalamic nucleus (STN), which correlate with symptom severity
No significant differences were shown in the power spectral density (PSD) estimates, coefficient of variation (CoV) or burst characteristics between PD-STN and PD-globus pallidus (GPi) datasets
We found that the characteristics of pallidal LF and beta bursts are similar between the parkinsonian GPi and STN, whereas significant differences were found in the amplitude/power of LF and beta oscillations between the parkinsonian and the dystonic GPi
Summary
Adaptive deep brain stimulation (aDBS) has been applied in Parkinson's disease (PD), based on the presence of brief high-amplitude beta (13–35 Hz) oscillation bursts in the subthalamic nucleus (STN), which correlate with symptom severity. The internal part of the globus pallidus (GPi) is currently the preferred target for conventional (continuous) deep brain stimulation (cDBS) in dystonia (Balint and Bhatia, 2014) and one of the two main targets for cDBS in Parkinson's disease (PD), together with the subthalamic nucleus (STN)(Odekerken et al, 2016). In both diseases, patients show a significant improvement after cDBS implantation, being around 30% improved in the Unified PD Rating Scale (UPDRS) part III in PD and demonstrating a motor and disability improvement up to 60% in isolated dystonia (Moro et al, 2017).
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