Local Field Potential-Guided Contact Selection Using Chronically Implanted Sensing Devices for Deep Brain Stimulation in Parkinson’s Disease

Abstract

Intra- and perioperatively recorded local field potential (LFP) activity of the nucleus subthalamicus (STN) has been suggested to guide contact selection in patients undergoing deep brain stimulation (DBS) for Parkinson’s disease (PD). Despite the invention of sensing capacities in chronically implanted devices, a comprehensible algorithm that enables contact selection using such recordings is still lacking. We evaluated a fully automated algorithm that uses the weighted average of bipolar recordings to determine effective monopolar contacts based on elevated activity in the beta band. LFPs from 14 hemispheres in seven PD patients with newly implanted directional DBS leads of the STN were recorded. First, the algorithm determined the stimulation level with the highest beta activity. Based on the prior determined level, the directional contact with the highest beta activity was chosen in the second step. The mean clinical efficacy of the contacts chosen using the algorithm did not statistically differ from the mean clinical efficacy of standard contact selection as performed in clinical routine. All recording sites were projected into MNI standard space to investigate the feasibility of the algorithm with respect to the anatomical boundaries of the STN. We conclude that the proposed algorithm is a first step towards LFP-based contact selection in STN-DBS for PD using chronically implanted devices.

Local Field Potentials Predict Motor Performance in Deep Brain Stimulation for Parkinson's Disease

“…However, our data suggests that the extent of beta power suppression constitutes a biomarker that is more closely related to short‐ and long‐term clinical improvement and programming settings, respectively, than directional beta power with stimulation turned OFF. This may be partly because of the processing steps needed to link biomarkers extracted from bipolarly acquired LFPs to single (directional) contacts, for which there is no gold standard 5 . Importantly, the strength of the association of both beta power suppression and directional beta power to motor performance will only allow to guide, but not to replace clinical programming.…”

“…This may be partly because of the processing steps needed to link biomarkers extracted from bipolarly acquired LFPs to single (directional) contacts, for which there is no gold standard. 5 Importantly, the strength of the association of both beta power suppression and directional beta power to motor performance will only allow to guide, but not to replace clinical programming. Combining image-guided algorithms 9 and other biomarkers such as β band activity will help to improve future programming algorithms.…”

“…First, segmented electrodes which allow for steering of the electric field and second, sensing‐enabled neurostimulators capable of recording local field potentials (LFPs) 3 . While segmented electrodes promise to increase therapeutic flexibility through directional stimulation, 4 sensing‐enabled neurostimulators provide a means to extract electrophysiological biomarkers that may aid clinical programming 5 …”

“…3 While segmented electrodes promise to increase therapeutic flexibility through directional stimulation, 4 sensing-enabled neurostimulators provide a means to extract electrophysiological biomarkers that may aid clinical programming. 5 Before segmented DBS electrodes were introduced, electric current could only be applied via ring contacts placed along the main axis of the DBS electrode. 3 However, deviations from the surgical target 6 may cause current spread to adjacent structures, potentially leading to therapy limiting side effects with ring stimulation.…”

Sensing with deep brain stimulation device in epilepsy: Aperiodic changes in thalamic local field potential during seizures

“…The sensing capabilities of this novel technology can be best understood in the context of PD. In clinic, data can be streamed in real‐time using the Survey mode to display power spectra across pairs of contacts, which may be used to inform the choice of active contact (i.e., contacts with maximal beta power) 8 . In addition, data can be recorded in patients' naturalistic settings using two different modes, referred to as Timeline and Event .…”