Objective: To evaluate the effect of subthalamic (STN) deep brain stimulation (DBS) on the globus pallidus (GP) and motor cortex

Background: Progressive neuronal loss in Parkinson’s disease (PD) leads to dysfunctional neural circuits. Local field potential (LFP) and cortical electrocorticography (ECoG) recordings have shed light to the pathological signals underlying PD. Elevated beta band (13-30 Hz) spectral power has been associated with bradykinesia and rigidity in the off-medication state, and finely tuned gamma-band activity (~70Hz) with dyskinesias in the on-medication state. Therapeutic STN DBS is thought to improve symptoms by normalizing these abnormal signals. However, the effect of STN DBS on pallidal activity and its coherence to the cortex is still unknown. In addition, comparing the effect of STN and GPi DBS on the cortex within the same patient has not been studied.

Method: A 53-year-old woman with PD underwent right GPi DBS implantation to supplement her existing bilateral STN DBS. The lead was placed with 2 contacts in the GP internus (GPi) and 2 in GP externus (GPe). An ECoG strip was temporarily placed over the precentral gyrus. Cortical and pallidal LFPs were simultaneously recorded while delivering therapeutic (180 Hz) and low frequency (10Hz) STN DBS. Primary motor cortex (M1) activity was also recorded during GPi and GPe stimulation. Due to baseline severe rigidity and dystonia, the patient took medication 2 hours before surgery. Power spectral density, coherence and evoked potentials were computed and compared across stimulation conditions.

Results: There was a strong beta peak in pallidum and a gamma peak in M1 in the DBS OFF state. This was associated with leg dyskinesia, severe arm rigidity and dystonia. The pallidum and M1 were highly coherent in beta and gamma bands. STN DBS improved arm rigidity/dystonia, associated with a reduction in pallidal beta power and M1 gamma power, and an increase in theta power in GPe and M1. GPi DBS reduced M1 gamma. But neither GPi nor GPe DBS influenced beta or theta power in M1. Beta and gamma GPi-M1 and Gpe-M1 coherence were reduced while theta GPe-M1 increased. Evoked potentials were found in M1 with 10Hz STN DBS but not GPi or GPe.

Conclusion: These results suggest different mechanisms of action of therapeutic STN and GPi DBS, potentially through the hyper direct pathway for the former, and involving different oscillatory patterns

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-effect-of-subthalamic-therapeutic-deep-brain-stimulation-on-pallidal-and-cortical-activity-in-parkinsons-disease/