Objective: Assess the feasibility of chronic subgaleal cortical sensing using two distinct recording leads.

Background: Pathological oscillatory activity in cortico-basal ganglia (BG) circuits is implicated in the etiology of motor symptoms in Parkinson’s disease (PD). Sensing-enabled deep brain stimulation (DBS) devices connected to subdural electrocorticography (ECoG) leads over sensorimotor cortex have revealed that changes in synchronized oscillatory activity throughout the cortex-BG motor network correlate with motor signs and therapeutic response. The emergence of adaptive DBS, which uses neural signals to adjust DBS stimulation based on changing brain needs, highlights the importance of identifying neurophysiological biomarkers that correlate with a variety of motor symptoms. Cortical biomarkers have emerged as promising feedback signals for adaptive DBS, but further studies have been limited by the invasive nature of subdural ECoG paddles. The use of less invasive under-the-scalp (e.g., subgaleal; SG) permanent leads to record cortical activity would minimize the risk associated with placing permanent electrodes directly on the surface of the brain and facilitate rapid scalability of adaptive DBS for PD using cortical signals.

Method: A 58-year-old female with tremor dominant PD was implanted with bilateral sensing-enabled DBS devices designed for long-term recording of neural time series data. Each device was connected to a directional lead targeting the subthalamic nucleus (STN) and a cortical lead placed in the SG space over sensorimotor cortex. For the cortical lead, an octopolar 10.5 mm segmented DBS lead was implanted over one side and an octopolar paddle type lead, normally used for spinal cord stimulation, was implanted over the other side. Field potential recordings from the four leads (2 SG and 2 STN) were conducted intra-operatively, and on post-operative day 1.

Results: Intraoperatively, both SG leads were able to detect low frequency (alpha-beta) sensorimotor activity. On post-operative day 1, the SG paddle detected alpha-beta activity during OFF and ON medication states.

Conclusion: These findings suggest that SG cortical recording from a permanent implant can detect sensorimotor activity in physiologically relevant frequency bands. Ongoing studies are investigating sensorimotor activity during various brain states.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/chronic-sensorimotor-cortex-sensing-using-permanently-implanted-subgaleal-leads-in-a-patient-receiving-deep-brain-stimulation-for-parkinsons-disease/