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

Sydnei Lewis; Erin Radcliffe; Steven Ojemann; Daniel R Kramer; Lisa Hirt; Michelle Case; Abbey B Holt-Becker; Robert Raike; Drew S Kern; John A Thompson

doi:10.1016/j.neurom.2023.01.006

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

Neuromodulation. 2024 Apr;27(3):509-519. doi: 10.1016/j.neurom.2023.01.006. Epub 2023 Feb 14.

Authors

Affiliations

¹ Biomedical Engineering, University of Colorado Boulder, Boulder, CO, USA.
² Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
³ Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁴ Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁵ Brain Modulation Business, Neuromodulation Operating Unit, Medtronic, Plc, Minneapolis, MN, USA.
⁶ Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. Electronic address: john.a.thompson@cuanschutz.edu.

PMID: 36797194
DOI: 10.1016/j.neurom.2023.01.006

Abstract

Background: Deep brain stimulation (DBS) programming is time intensive. Recent advances in sensing technology of local field potentials (LFPs) may enable improvements. Few studies have compared the use of this technology with standard of care.

Objective/hypothesis: Sensing technology of subthalamic nucleus (STN) DBS leads in Parkinson's disease (PD) is reliable and predicts the optimal contacts and settings as predicted by clinical assessment.

Materials and methods: Five subjects with PD (n = 9 hemispheres) with bilateral STN DBS and sensing capable battery replacement were recruited. An LFP sensing review of all bipolar contact pairs was performed three times. Contact with the maximal beta peak power (MBP) was then clinically assessed in a double-blinded fashion, and five conditions were tested: 1) entry settings, 2) off stimulation, 3) MBP at 30 μs, 4) MBP at 60 μs, and 5) MBP at 90 μs.

Results: Contact and frequency of the MBP power in all hemispheres did not differ across sessions. The entry settings matched with the contact with the MBP power in 5 of 9 hemispheres. No clinical difference was evident in the stimulation conditions. The clinician and subject preferred settings determined by MBP power in 7 of 9 and 5 of 7 hemispheres, respectively.

Conclusions: This study indicates that STN LFPs in PD recorded directly from contacts of the DBS lead provide consistent recordings across the frequency range and a reliably detected beta peak. Furthermore, programming based on the MBP power provides at least clinical equivalence to standard of care programming with STN DBS.

Keywords: Beta frequency; Parkinson’s disease; deep brain stimulation; initial programming; local field potential; sensing.

MeSH terms

Deep Brain Stimulation*
Humans
Parkinson Disease* / therapy
Pilot Projects
Subthalamic Nucleus* / physiology