Objective: To describe the continuous recording of STN local field potentials (LFPs) and their response to electrical stimulation and sleep in a Parkinson’s disease (PD) patient after STN DBS.

Background: STN DBS is effective in PD patients with disabling motor complications under optimized medical therapy. Stimulation parameters are classically set during assessment of clinical benefits and adverse effects derived from the combination of several variables (e.g. selected contact, energy-related parameters). STN beta-band LFPs correlate with bradykinesia and rigidity in PD patients, suggesting their usefulness as clinical surrogate markers. However, real world data on this matter is currently scarce.

Method: We describe new real world long term (>6 weeks) data concerning LFP recording and response to stimulation and sleep in a PD patient. A 70-year old female with PD motor symptoms for more than 10 years, and disabling motor complications was offered STN DBS. The procedure was performed under local anesthesia using 3 trajectories per hemisphere. Final electrode location was selected after micro-electrode recording, and assessment of clinical benefits derived from intra-operative stimulation. A new generation implantable pulse generator (IPG) incorporating the ability to sense and chronically record LFPs was placed in infraclavicular position. LFPs were recorded since the immediate post-operative period.

Results: LFPs were easily recorded. During awake time, while off dopaminergic medication and off stimulation, the beta-band power is much higher. Turning stimulation on causes an immediate decrement of beta-band power, and a “ceiling effect” is clearly seen as stimulation amplitude reaches a maximally suppressed beta level without further impact of stimulation escalation. Beta-band power is clearly much lower during sleep, even without night time dopaminergic drugs. All these findings are noticeable in both brain hemispheres.

Conclusion: Real world LFP recording after STN DBS in PD is a straightforward process. Beta-band LFP power is clearly influenced by electrical stimulation parameters and sleep, and correlates with clinical benefits. Further research might provide valuable clues to guide the optimization of DBS parameters in these patients.
Acknowledgments: Armando Fernandes, João Branco, Miguel Dias (Medtronic Portugal) and Scott Stanslaski (Medtronic USA), for technical support.

References: 1. Brittain J-S, Sharott A, Brown P. The Highs and Lows of Beta Activity in Cortico-Basal Ganglia Loops. Eur J Neurosci 2014;39:1951–1959. 2. Weiss D, Massano J. Approaching Adaptive Control in Neurostimulation for Parkinson Disease: Autopilot On. Neurology 2018;90:497-498. 3. Arlotti M, et al. Eight-hours Adaptive Deep Brain Stimulation in Patients With Parkinson Disease. Neurology 2018;90:e971-e976. 4. Soares MI, Soares-dos-Reis R, Rosas MJ, Monteiro P, Massano J. Intraoperative Microelectrode Recording in Parkinson’s Disease Subthalamic Deep Brain Stimulation: Analysis of Clinical Utility. J Clin Neurosci 2019;69:104-108.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/human-stn-local-field-potentials-recording-and-stimulation-and-sleep-response-in-parkinsons-disease-after-deep-brain-stimulation/