Pilot Study to Investigate the Use of In-Clinic Sensing to Identify Optimal Stimulation Parameters for Deep Brain Stimulation Therapy in Parkinson’s Disease

Towards an objective, standardized beta frequency peak detection algorithm to inform adaptive deep brain stimulation programming in Parkinson’s disease

“…Clinical evidence from human studies supports the growing consensus that LFP activity within this beta range is implicated in tonic movement 15,18,19 , is strongly correlated with rigidity and bradykinesia [20][21][22] , and that attenuation of beta power by dopaminergic medication and DBS results in symptom improvement 6, [12][13][14][15]19,[23][24][25] . Associations with symptom improvement are further supported by targeting the lower beta band (~ 13-20Hz) 15,23,24,[26][27][28][29] , although there are reports of upper beta band (~ 20-30Hz) activity correlating with freezing of gait 27,30,31 and governing lower limb activity 32 . As such, speci c relationships between the upper/lower beta band and clinical outcomes are debated but nonetheless implicative for aDBS therapies.…”

“…Within the dorsolateral STN of patients with PD, local eld potentials (LFPs), frequently exhibit increased oscillatory synchrony and elevated peak power in the beta frequency range of 13-30Hz 6, [11][12][13][14][15][16][17] . Clinical evidence from human studies supports the growing consensus that LFP activity within this beta range is implicated in tonic movement 15,18,19 , is strongly correlated with rigidity and bradykinesia [20][21][22] , and that attenuation of beta power by dopaminergic medication and DBS results in symptom improvement 6, [12][13][14][15]19,[23][24][25] . Associations with symptom improvement are further supported by targeting the lower beta band (~ 13-20Hz) 15,23,24,[26][27][28][29] , although there are reports of upper beta band (~ 20-30Hz) activity correlating with freezing of gait 27,30,31 and governing lower limb activity 32 .…”

“…Maximal amplitude beta peak (MBP) presence in LFP power spectral densities (PSD) were strongly related to the "electrophysiological sweet spot" for lead placement in 92% of patients undergoing DBS 6,33 . As such, several studies have corroborated the utility of PSDs to identify the MBP to guide clinical decisions on DBS contact selection and parameterization to suppress beta power, which generally elicits clinical bene t 6,8, 12,18,24,34 . While current clinical-commercial tools, including those from Medtronic, Newronika 35 , and PINS 36 permit spectral analysis, there remains a need to systematically quantify LFP peaks from the displayed PSD [Figure 1].…”

“…Currently, the standard practice uses bipolar sensing montages to determine optimal DBS contact placement 37 . This conventional practice details meticulous comparison of MBP between contact pairs, denoted by the largest difference in pairs, which is largely reliant on trialand-error and requires expertise in interpreting computed results 12,24 . To relieve this clinical burden and optimize the clinical work ow, an e cient peak detection algorithm could be integrated.…”

Proceedings of the 11th Annual Deep Brain Stimulation Think Tank: pushing the forefront of neuromodulation with functional network mapping, biomarkers for adaptive DBS, bioethical dilemmas, AI-guided neuromodulation, and translational advancements

“…Evidence is building that BrainSense may be used to guide DBS programming setup and optimization in movements disorders and epilepsy (Feldmann et al, 2021 ; Buijink et al, 2022 ; Fasano et al, 2022 ; Strelow et al, 2022 ; Chua et al, 2023 ; Swinnen et al, 2023 ). Recent studies in Parkinson's disease suggest BrainSense can be used to streamline and reduce the time for initial DBS programming (Binder et al, 2023 ; Lewis et al, 2023 ), troubleshoot difficult cases, identify medication interactions, and mitigate potential overstimulation (Kern et al, 2022 ; Vaou et al, 2023 ). Simplified data visualizations are also being developed to expand access to the insights learned to date (Thompson et al, 2023 ).…”