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Baker SK, Radcliffe EM, Kramer DR, Ojemann S, Case M, Zarns C, Holt-Becker A, Raike RS, Baumgartner AJ, Kern DS, Thompson JA. Comparison of beta peak detection algorithms for data-driven deep brain stimulation programming strategies in Parkinson's disease. NPJ Parkinsons Dis 2024; 10:150. [PMID: 39122725 PMCID: PMC11315991 DOI: 10.1038/s41531-024-00762-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024] Open
Abstract
Oscillatory activity within the beta frequency range (13-30 Hz) serves as a Parkinson's disease biomarker for tailoring deep brain stimulation (DBS) treatments. Currently, identifying clinically relevant beta signals, specifically frequencies of peak amplitudes within the beta spectral band, is a subjective process. To inform potential strategies for objective clinical decision making, we assessed algorithms for identifying beta peaks and devised a standardized approach for both research and clinical applications. Employing a novel monopolar referencing strategy, we utilized a brain sensing device to measure beta peak power across distinct contacts along each DBS electrode implanted in the subthalamic nucleus. We then evaluated the accuracy of ten beta peak detection algorithms against a benchmark established by expert consensus. The most accurate algorithms, all sharing similar underlying algebraic dynamic peak amplitude thresholding approaches, matched the expert consensus in performance and reliably predicted the clinical stimulation parameters during follow-up visits. These findings highlight the potential of algorithmic solutions to overcome the subjective bias in beta peak identification, presenting viable options for standardizing this process. Such advancements could lead to significant improvements in the efficiency and accuracy of patient-specific DBS therapy parameterization.
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Affiliation(s)
- Sunderland K Baker
- Pennsylvania State University, Department of Biobehavioral Health, University Park, PA, 16802, USA
| | - Erin M Radcliffe
- University of Colorado Anschutz Medical Campus, Department of Neurosurgery, Aurora, CO, 80045, USA
- University of Colorado Anschutz Medical Campus, Department of Bioengineering, Aurora, CO, 80045, USA
| | - Daniel R Kramer
- University of Colorado Anschutz Medical Campus, Department of Neurosurgery, Aurora, CO, 80045, USA
| | - Steven Ojemann
- University of Colorado Anschutz Medical Campus, Department of Neurosurgery, Aurora, CO, 80045, USA
- University of Colorado Anschutz Medical Campus, Department of Neurology, Aurora, CO, 80045, USA
| | - Michelle Case
- Medtronic PLC, Neuromodulation Operating Unit, Minneapolis, MN, 55432, USA
| | - Caleb Zarns
- Medtronic PLC, Neuromodulation Operating Unit, Minneapolis, MN, 55432, USA
| | - Abbey Holt-Becker
- Medtronic PLC, Neuromodulation Operating Unit, Minneapolis, MN, 55432, USA
| | - Robert S Raike
- Medtronic PLC, Neuromodulation Operating Unit, Minneapolis, MN, 55432, USA
| | - Alexander J Baumgartner
- University of Colorado Anschutz Medical Campus, Department of Neurosurgery, Aurora, CO, 80045, USA
- University of Colorado Anschutz Medical Campus, Department of Neurology, Aurora, CO, 80045, USA
| | - Drew S Kern
- University of Colorado Anschutz Medical Campus, Department of Neurosurgery, Aurora, CO, 80045, USA
- University of Colorado Anschutz Medical Campus, Department of Neurology, Aurora, CO, 80045, USA
| | - John A Thompson
- University of Colorado Anschutz Medical Campus, Department of Neurosurgery, Aurora, CO, 80045, USA.
- University of Colorado Anschutz Medical Campus, Department of Neurology, Aurora, CO, 80045, USA.
- University of Colorado Anschutz Medical Campus, Department of Psychiatry, Aurora, CO, 80045, USA.
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Peng C, Wang Z, Sun Y, Mo Y, Hu K, Li Q, Hou X, Zhu Z, He X, Xue S, Zhang S. Subthalamic nucleus dynamics track microlesion effect in Parkinson's disease. Front Cell Dev Biol 2024; 12:1370287. [PMID: 38434618 PMCID: PMC10906266 DOI: 10.3389/fcell.2024.1370287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Parkinson's Disease (PD) is characterized by the temporary alleviation of motor symptoms following electrode implantation (or nucleus destruction), known as the microlesion effect (MLE). Electrophysiological studies have explored different PD stages, but understanding electrophysiological characteristics during the MLE period remains unclear. The objective was to examine the characteristics of local field potential (LFP) signals in the subthalamic nucleus (STN) during the hyperacute period following implantation (within 2 days) and 1 month post-implantation. 15 patients diagnosed with PD were enrolled in this observational study, with seven simultaneous recordings of bilateral STN-LFP signals using wireless sensing technology from an implantable pulse generator. Recordings were made in both on and off medication states over 1 month after implantation. We used a method to parameterize the neuronal power spectrum to separate periodic oscillatory and aperiodic components effectively. Our results showed that beta power exhibited a significant increase in the off medication state 1 month after implantation, compared to the postoperative hyperacute period. Notably, this elevation was effectively attenuated by levodopa administration. Furthermore, both the exponents and offsets displayed a decrease at 1 month postoperatively when compared to the hyperacute postoperative period. Remarkably, levodopa medication exerted a modulatory effect on these aperiodic parameters, restoring them back to levels observed during the hyperacute period. Our findings suggest that both periodic and aperiodic components partially capture distinct electrophysiological characteristics during the MLE. It is crucial to adequately evaluate such discrepancies when exploring the mechanisms of MLE and optimizing adaptive stimulus protocols.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sha Xue
- Neurosurgery Center, Department of Functional Neurosurgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shizhong Zhang
- Neurosurgery Center, Department of Functional Neurosurgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Peeters J, Van Bogaert T, Boogers A, Dembek TA, Gransier R, Wouters J, Vandenberghe W, De Vloo P, Nuttin B, Mc Laughlin M. EEG-based biomarkers for optimizing deep brain stimulation contact configuration in Parkinson's disease. Front Neurosci 2023; 17:1275728. [PMID: 37869517 PMCID: PMC10585033 DOI: 10.3389/fnins.2023.1275728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023] Open
Abstract
Objective Subthalamic deep brain stimulation (STN-DBS) is a neurosurgical therapy to treat Parkinson's disease (PD). Optimal therapeutic outcomes are not achieved in all patients due to increased DBS technological complexity; programming time constraints; and delayed clinical response of some symptoms. To streamline the programming process, biomarkers could be used to accurately predict the most effective stimulation configuration. Therefore, we investigated if DBS-evoked potentials (EPs) combined with imaging to perform prediction analyses could predict the best contact configuration. Methods In 10 patients, EPs were recorded in response to stimulation at 10 Hz for 50 s on each DBS-contact. In two patients, we recorded from both hemispheres, resulting in recordings from a total of 12 hemispheres. A monopolar review was performed by stimulating on each contact and measuring the therapeutic window. CT and MRI data were collected. Prediction models were created to assess how well the EPs and imaging could predict the best contact configuration. Results EPs at 3 ms and at 10 ms were recorded. The prediction models showed that EPs can be combined with imaging data to predict the best contact configuration and hence, significantly outperformed random contact selection during a monopolar review. Conclusion EPs can predict the best contact configuration. Ultimately, these prediction tools could be implemented into daily practice to ease the DBS programming of PD patients.
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Affiliation(s)
- Jana Peeters
- Experimental Oto-rhino-laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Tine Van Bogaert
- Experimental Oto-rhino-laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Alexandra Boogers
- Experimental Oto-rhino-laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Till Anselm Dembek
- Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Robin Gransier
- Experimental Oto-rhino-laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Jan Wouters
- Experimental Oto-rhino-laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Wim Vandenberghe
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Laboratory for Parkinson Research, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Philippe De Vloo
- Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Nuttin
- Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Myles Mc Laughlin
- Experimental Oto-rhino-laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
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Avantaggiato F, Farokhniaee A, Bandini A, Palmisano C, Hanafi I, Pezzoli G, Mazzoni A, Isaias IU. Intelligibility of speech in Parkinson's disease relies on anatomically segregated subthalamic beta oscillations. Neurobiol Dis 2023; 185:106239. [PMID: 37499882 DOI: 10.1016/j.nbd.2023.106239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/16/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Speech impairment is commonly reported in Parkinson's disease and is not consistently improved by available therapies - including deep brain stimulation of the subthalamic nucleus (STN-DBS), which can worsen communication performance in some patients. Improving the outcome of STN-DBS on speech is difficult due to our incomplete understanding of the contribution of the STN to fluent speaking. OBJECTIVE To assess the relationship between subthalamic neural activity and speech production and intelligibility. METHODS We investigated bilateral STN local field potentials (LFPs) in nine parkinsonian patients chronically implanted with DBS during overt reading. LFP spectral features were correlated with clinical scores and measures of speech intelligibility. RESULTS Overt reading was associated with increased beta-low ([1220) Hz) power in the left STN, whereas speech intelligibility correlated positively with beta-high ([2030) Hz) power in the right STN. CONCLUSION We identified separate contributions from frequency and brain lateralization of the STN in the execution of an overt reading motor task and its intelligibility. This subcortical organization could be exploited for new adaptive stimulation strategies capable of identifying the occurrence of speaking behavior and facilitating its functional execution.
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Affiliation(s)
- Federica Avantaggiato
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany.
| | - AmirAli Farokhniaee
- Fondazione Grigioni per il Morbo di Parkinson, Via Gianfranco Zuretti 35, 20125 Milano, Italy.
| | - Andrea Bandini
- The BioRobotics Institute, Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggo 34, Pontedera, Pisa, Italy; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggo 34, Pontedera, Pisa, Italy.
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany; Parkinson Institute Milan, ASST G. Pini-CTO, via Bignami 1, 20126 Milano, Italy.
| | - Ibrahem Hanafi
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany.
| | - Gianni Pezzoli
- Fondazione Grigioni per il Morbo di Parkinson, Via Gianfranco Zuretti 35, 20125 Milano, Italy; Parkinson Institute Milan, ASST G. Pini-CTO, via Bignami 1, 20126 Milano, Italy.
| | - Alberto Mazzoni
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggo 34, Pontedera, Pisa, Italy.
| | - Ioannis U Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany; Parkinson Institute Milan, ASST G. Pini-CTO, via Bignami 1, 20126 Milano, Italy.
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Averna A, Debove I, Nowacki A, Peterman K, Duchet B, Sousa M, Bernasconi E, Alva L, Lachenmayer ML, Schuepbach M, Pollo C, Krack P, Nguyen TAK, Tinkhauser G. Spectral Topography of the Subthalamic Nucleus to Inform Next-Generation Deep Brain Stimulation. Mov Disord 2023; 38:818-830. [PMID: 36987385 PMCID: PMC7615852 DOI: 10.1002/mds.29381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/13/2023] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The landscape of neurophysiological symptoms and behavioral biomarkers in basal ganglia signals for movement disorders is expanding. The clinical translation of sensing-based deep brain stimulation (DBS) also requires a thorough understanding of the anatomical organization of spectral biomarkers within the subthalamic nucleus (STN). OBJECTIVES The aims were to systematically investigate the spectral topography, including a wide range of sub-bands in STN local field potentials (LFP) of Parkinson's disease (PD) patients, and to evaluate its predictive performance for clinical response to DBS. METHODS STN-LFPs were recorded from 70 PD patients (130 hemispheres) awake and at rest using multicontact DBS electrodes. A comprehensive spatial characterization, including hot spot localization and focality estimation, was performed for multiple sub-bands (delta, theta, alpha, low-beta, high-beta, low-gamma, high-gamma, and fast-gamma (FG) as well as low- and fast high-frequency oscillations [HFO]) and compared to the clinical hot spot for rigidity response to DBS. A spectral biomarker map was established and used to predict the clinical response to DBS. RESULTS The STN shows a heterogeneous topographic distribution of different spectral biomarkers, with the strongest segregation in the inferior-superior axis. Relative to the superiorly localized beta hot spot, HFOs (FG, slow HFO) were localized up to 2 mm more inferiorly. Beta oscillations are spatially more spread compared to other sub-bands. Both the spatial proximity of contacts to the beta hot spot and the distance to higher-frequency hot spots were predictive for the best rigidity response to DBS. CONCLUSIONS The spatial segregation and properties of spectral biomarkers within the DBS target structure can additionally be informative for the implementation of next-generation sensing-based DBS. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alberto Averna
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Ines Debove
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andreas Nowacki
- Department of Neurosurgery, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Katrin Peterman
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Benoit Duchet
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, United Kingdom
| | - Mário Sousa
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Elena Bernasconi
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Laura Alva
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Martin L. Lachenmayer
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Claudio Pollo
- Department of Neurosurgery, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Paul Krack
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thuy-Anh K. Nguyen
- Department of Neurosurgery, Bern University Hospital and University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Gerd Tinkhauser
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
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Munhoz RP, Albuainain G. Deep brain stimulation - New programming algorithms and teleprogramming. Expert Rev Neurother 2023; 23:467-478. [PMID: 37115193 DOI: 10.1080/14737175.2023.2208749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Thanks to a variety of factors, the field of neuromodulation has evolved significantly over the past decade. Developments include new indications and innovations of hardware, software, and stimulation techniques leading to an expansion in scope and role of these techniques as powerful therapies. They also imply the realization that practical application involves new nuances that make patient selection, surgical technique and the programming process even more complex, requiring continuous education and an organized structured approach. AREAS COVERED In this review, the authors explore the developments in deep brain stimulation technology, including electrodes, implantable pulse generators, contact configurations (i.e, directional leads and independent current control), remote programming and sensing using local field potentials. EXPERT OPINION The innovations in the field of deep brain stimulation discussed in this review potentially provide increased effectiveness and flexibility not only to improve therapeutic response but also to address troubleshooting challenges seen in clinical practice. Directional leads and shorter pulse widths may broaden the therapeutic window of stimulation, avoiding current spread to structures that might trigger stimulation-related side effects. Similarly, independent control of current to individual contacts allows for the shaping of the electric field. Finally, sensing and remote programming represent important developments for more effective and individualized patient care.
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Affiliation(s)
- Renato Puppi Munhoz
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, Toronto, ON, M5T 2S8, Canada
| | - Ghadh Albuainain
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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Morelli N, Summers RLS. Association of subthalamic beta frequency sub-bands to symptom severity in patients with Parkinson's disease: A systematic review. Parkinsonism Relat Disord 2023; 110:105364. [PMID: 36997437 DOI: 10.1016/j.parkreldis.2023.105364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Local field potentials (LFP), specifically beta (13-30Hz) frequency measures, have been found to be associated with motor dysfunction in people with Parkinson's disease (PwPD). A consensus on beta subband (low- and high-beta) relationships to clinical state or therapy response has yet to be determined. The objective of this review is to synthesize literature reporting the association of low- and high-beta characteristics to clinical ratings of motor symptoms in PwPD. METHODS A systematic search of existing literature was completed using EMBASE. Articles which collected subthalamic nucleus (STN) LFPs using macroelectrodes in PwPD, analyzed low- (13-20 Hz) and high-beta (21-35 Hz) bands, collected UPDRS-III, and reported correlational strength or predictive capacity of LFPs to UPDRS-III scores. RESULTS The initial search yielded 234 articles, with 11 articles achieving inclusion. Beta measures included power spectral density, peak characteristics, and burst characteristics. High-beta was a significant predictor of UPDRS-III responses to therapy in 5 (100%) articles. Low-beta was significantly associated with UPDRS-III total score in 3 (60%) articles. Low- and high-beta associations to UPDRS-III subscores were mixed. CONCLUSION This systematic review reinforces previous reports that beta band oscillatory measures demonstrate a consistent relationship to Parkinsonian motor symptoms and ability to predict motor response to therapy. Specifically, high-beta, demonstrated a consistent ability to predict UPDRS-III responses to common PD therapies, while low-beta measures were associated with general Parkinsonian symptom severity. Continued research is needed to determine which beta subband demonstrates the greatest association to motor symptom subtypes and potentially offers clinical utility toward LFP-guided DBS programming and adaptive DBS.
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