Objective: To characterize the neural effects of burst DBS (bDBS) on cortico-subthalamic circuit dynamics in Parkinson’s disease (PD) and determine whether they differ from conventional high-frequency DBS (cDBS).

Background: cDBS effectively treats PD motor symptoms, but the optimal stimulation pattern for modulating motor circuits remains unclear. As part of a Boston Scientific-sponsored RESET DBS trial (clinicaltrials.gov NCT07340073), we investigated a patterned burst paradigm delivering pulse trains interleaved with stimulation-off periods.

Method: Scalp hdEEG was recorded in 9 PD patients off medication across five conditions: stimulation OFF, cDBS, and up to three individualized burst settings varying burst duration (BD,500-900 ms) and interburst duration (IBD,100-400 ms). Bilateral STN and MCx source time series were reconstructed using EEG source localization. Features included aperiodic exponent, beta burst dynamics, MCx-STN beta coherence, phase-amplitude coupling, and directional connectivity (PSI). Condition effects were tested with linear mixed-effects models; contrasts used Wilcoxon signed-rank.

Results: Both cDBS and bDBS modulated cortico-subthalamic dynamics relative to stimulation OFF. Compared with cDBS, bDBS reduced MCx-STN beta coherence in the low- and high-beta ranges (−9% and −11%,both p=0.031) and selectively flattened the MCx aperiodic exponent (−10%,p=0.031). STN aperiodic exponent was flatter during bDBS than stimulation OFF (−20%,p=0.039), overall condition effect significant (p=0.014), although the bDBS-versus-cDBS contrast was not significant (−8%,p=0.297). STN-MCx directional influence showed the strongest overall condition effect (p=0.001), and STN high-beta phase–MCx low-gamma coupling varied significantly by condition (p=0.002). Within bDBS, increasing duty cycle shifted cortical low-beta dynamics toward shorter and more frequent bursts (both p=0.031), without altering low-beta power (p=0.438).

Conclusion: Compared with cDBS, bDBS weakened cortico-subthalamic beta synchrony, shifted broadband cortical activity, and altered signaling from STN to motor cortex, with additional condition-dependent effects on STN aperiodic activity and cross-frequency coupling. These findings suggest that temporal patterning modifies cortico-subthalamic network physiology distinctly from cDBS, supporting further evaluation of BD/IBD-defined bDBS in larger clinical studies.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/burst-versus-conventional-deep-brain-stimulation-engage-distinct-cortico-subthalamic-circuit-dynamics-in-parkinsons-disease/