Objective: To compare short-term motor, non-motor, and quality-of-life outcomes following LFP-guided versus clinically- guided electrode selection for cDBS of GPi in PD

Background: Local field potentials (LFPs) in the alpha–beta frequency band (8–30 Hz) correlate with bradykinesia and rigidity and may help identify optimal stimulation sites (“sweet spots”) for deep brain stimulation (DBS) in Parkinson’s disease (PD). Data on LFP-guided continuous DBS (cDBS) for globus pallidus internus (GPi) are limited

Method: In this prospective, non-randomised, cohort study, PD patients undergoing bilateral cDBS of GPi over 2 years were recruited. In patients implanted with sensing-enabled DBS systems, highest alpha- or beta-band peak power was used for electrode identification. If alpha-beta band power or clinical benefit was suboptimal, clinically- guided electrode selection was used. UPDRS parts III and IV, Non-Motor Symptoms Scale (NMSS), Parkinson’s Disease Questionnaire-39 (PDQ-39), Frontal Assessment Battery (FAB), Montreal Cognitive Assessment (MoCA), Beck Depression Inventory (BDI), and Parkinson’s Disease Sleep Scale (PDSS) were applied before and 3 months after DBS

Results: Seventy-three patients (43 males) participated. Mean age was 63 ± 6.9 years and mean disease duration was 10 ± 4.9 years. In 23 cases with sensing-enabled DBS systems, 18 (78%) demonstrated alpha-beta LFP peaks during BrainSense^TM survey. The mean alpha-beta band power was 2.25 ± 1.34 mVp in the left GPi and 15.17 ± 4.60 mVp in the right GPi, with median frequencies of 15.63 Hz and 13.67 Hz respectively.  Ten out of 18 patients with suboptimal alpha-beta power or clinical response were excluded from the LFP-guided group while 50 received clinically-guided cDBS.

After adjustment of baseline characterisits and pre-DBS clinical scores, there were no significant differences between groups in UPDRS-III (p=0.778), UPDRS-IV (p=0.44), MoCA (p=0.413), BDI (p=0.272), PDQ-39 (p=0.194), NMSS, FAB, or PDSS scores

Conclusion: Alpha-beta frequency in LFP activity was detectable in approximately 72–78% of patients but was usable only for cBS in 44%. Clinical outcomes were comparable between the two modes of electrode identification used for cDBS

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MDS Abstracts - https://www.mdsabstracts.org/abstract/local-field-potential-guided-versus-clinically-guided-electrode-identification-for-continuous-gpi-dbs-in-parkinsons-disease/