Objective: To evaluate the potential of aperiodic and periodic neural activity in guiding clinical deep brain stimulation (DBS) programming for children with dystonia.

Background: DBS is a promising treatment for children with medically refractory acquired and genetic dystonia. However, optimizing DBS programming is challenging due to its reliance on a lengthy, open-loop, trial-and-error process. Additionally, improvements may take weeks to months to manifest after programming changes. The absence of reliable, predictive brain-based biomarkers for DBS programming is a critical knowledge gap.

Method: This retrospective study examined the utility of local field potentials (LFPs) in predicting the clinically selected electrode. We compared periodic and aperiodic activity recorded at each electrode during the initial DBS programming visit (monopolar review) with the final clinically selected electrode. During initial DBS programming visits, we collected resting globus pallidus pars interna (GPi) LFP data from pediatric and young adult patients using the Percept PC (Medtronic, USA) neurostimulator. We used spectral parameterization modeling to separate broadband neural power spectra into periodic (theta: 4-8 Hz; alpha: 8-13 Hz; low beta 13-20 Hz; high beta: 20-30 Hz; gamma: 30-50 Hz) and aperiodic (spectral exponent, spectral offset) components. Patients then underwent standard clinical programming sessions without consideration of LFP data.

Results: Fifteen GPi hemispheres from eight patients (median age: 10.5 years, range: 7.9-20.6 years) were included. Periodic and aperiodic activity at the initial DBS programming session corresponded with the final clinically selected electrode as follows: lowest spectral offset (10/15), lowest spectral exponent (9/15), greatest theta peak power (7/15) and bandwidth (9/15), greatest high beta peak power (5/15) and bandwidth (8/15), greatest gamma peak power (6/15) and bandwidth (5/15), greatest low beta peak power (4/15) and bandwidth (4/15), and alpha peak power (0/15) and bandwidth (5/15).

Conclusion: Our findings suggest that periodic and aperiodic GPi activity may be useful in selecting DBS electrodes for childhood dystonia. Specifically, aperiodic activity (spectral offset and exponent), theta, and high beta activity may provide valuable information for electrode selection. Future prospective studies are needed to confirm these findings.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/exploring-the-role-of-aperiodic-and-periodic-spectral-activity-in-guiding-deep-brain-stimulation-electrode-selection-for-childhood-dystonia/