Objective: To report correlations of intraoperative local field potentials (LFPs) with longitudinal selection of optimal deep brain stimulation (DBS) programming contacts in patients with essential tremor (ET) and Parkinson’s disease (PD).

Background: Alpha and theta oscillatory LFPs in the ventralis intermediate nucleus of the thalamus (VIM) are implicated in the pathophysiology of ET and higher beta band LFPs within subthalamic nucleus (STN) and globus pallidus interna (GPi) are found to be correlated to symptoms in PD. Determining the contacts where these LFPs are highest intraoperatively can potentially help predict optimal DBS programming contact to stimulate for control of symptoms in ET and PD. We reviewed intraoperative LFP data for highest alpha/theta or beta activity in ET and PD respectively and compared with the latest programming data available to determine whether DBS contacts used in clinic corresponded to the highest intraoperative LFP contact.

Method: 20 consecutive DBS leads in ET and PD patients with intraoperative LFP data were retrospectively analyzed. Mean time since surgery for most recent programming session was 12.5 months (range 3.6-16.6) for ET (n=9) and 7.9 months (range 2.6-15.0) for PD (n=11).

Results: 5/9 (56%) of ET patients had their best stimulation contact at most recent programming session correspond to the highest alpha/theta LFP contact at time of surgery. The remaining 4/9 (44%) were using the contact immediately above the highest alpha/theta LFP contact due to adverse effects at the contact with highest alpha/theta LFP.

7/11 (64%) of PD patients (3 GPi and 4 STN) at most recent programming session were using a DBS contact that had the highest omnidirectional beta oscillatory LFP during intraoperative surgical monitoring or the programming settings encompassed the contact within the field of stimulation (such as in bipolar settings). The remaining 4/11 (36%) (4 STN) were utilizing a contact for stimulation that was either above or below by one level to the highest beta oscillatory LFP contact.

Conclusion: Intraoperative LFPs can be useful in determining or predicting the long-term best contact for stimulation in both ET and PD and may aid with intraoperative decision making for best DBS lead placement.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/intraoperative-local-field-potentials-and-selection-of-deep-brain-stimulation-programming-contacts-in-patients-with-essential-tremor-and-parkinsons-disease/