Objective: To evaluate potential use and applicability of local field potential-guided DBS-programming under real-life conditions in a Parkinson’s disease (PD) outpatient clinic.

Background: Deep brain stimulation (DBS) is a standardized therapeutic option for PD patients in advanced stages of the disease with ongoing technical development, i.e. using directional leads. DBS programming is still mostly based on clinical response testing to identify the optimal electrode contact in terms of efficacy and side effects, also referred to as monopolar review. However, monopolar review is often a demanding and time-consuming process depending on substantial expertise and training and requires patients to undergo an extended examination.¹ Local field potential-guided contact selection using chronically implanted sensing devices is able to measure elevated activity in the beta band.² Previous studies have already shown that the measurement of the LFP level in the medication OFF state can be used to determine the optimal contact.³

Method: We examined n=10 PD patients (age 62.6 ± 6.6y; f/m 3/7) who underwent DBS targeting the nucleus subthalamicus (STN). The mean disease duration was 8 ± 3.9y, the mean stage after Hoehn and Yahr was 2.4 ± 0.6. All patients suffered from motor fluctuations with end-of-dose phenomena and were under accompanying oral levodopa therapy. Beta peak evaluation was performed bilateral under following conditions: Medication OFF/StimulationON; MedicationOFF/StimulationOFF (at least 45min); MedicationON/StimulationON and shortly before taking the next dose of levodopa (end-of-dose time point) with subsequent measurement of beta activity at each condition, as well as determination of the optimal contact based on the LFP-level. In addition, the optimal contact was determined based on MRI/CT imaging data.

Results: A reproducible beta peak was recorded at n=9 out of 10 patients in medication as well as stimulation ON and OFF and at end-of-dose time point (see picture 1 & 2). A positive correlation with radiological data was found as well.

Conclusion: In our pilot study, we were able to show the usefulness and practicability of LFP-guided programming in DBS PD patients under real-life conditions in a PD outpatient clinic. An examination in medical or stimulation OFF does not seem to provide further clinical helpful information for DBS setting, so subsequently programming can be performed at any given time.

medication off

end-of-dose time point

References: 1. Lange F, Steigerwald F, Malzacher T, Brandt GA, Odorfer TM, Roothans J, Reich MM, Fricke P, Volkmann J, Matthies C and Capetian PD (2021) Reduced Programming Time and Strong Symptom Control Even in Chronic Course Through Imaging-Based DBS Programming. Front. Neurol. 12:785529. doi: 10.3389/fneur.2021.78552.
2. Strelow JN, Dembek TA, Baldermann JC, et al. Local Field Potential-Guided Contact Selection Using Chronically Implanted Sensing devices für Deep Brain Stimulation in Parkinson’s disease. Brain Sci 2022;12:1726.
3. Feasibility of local field potential-guided programming for deep brain stimulation in Parkinson’s disease: A comparison with clinical and neuro-imaging guided approaches in a randomized, controlled pilot trial Binder, Tobias et al. Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, Volume 16, Issue 5, 1243 – 1251

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MDS Abstracts - https://www.mdsabstracts.org/abstract/evaluation-of-local-field-potential-guided-dbs-programming-in-a-parkinsons-disease-outpatient-clinic/