Objective: To describe pallidal local field potential (LFP) recordings and their clinical correlates in a patient with acquired generalized dystonia secondary to kernicterus undergoing bilateral globus pallidus internus (GPi) deep brain stimulation (DBS).

Background: Acquired dystonia is often severe and poorly responsive to pharmacological therapy, with variable outcomes after GPi DBS (1). Assessing DBS efficacy is challenging because clinical effects may be delayed and symptoms fluctuate. LFP recordings from DBS electrodes provide neurophysiological insights that may support biomarker-guided neuromodulation (2, 3). Data on chronic LFP recordings in acquired dystonia remain limited.

Method: A 25-year-old woman with severe generalized dystonia secondary to kernicterus underwent bilateral GPi DBS. Survey recordings were performed during initial programming to identify oscillatory peaks that guided contact selection and stimulation settings. Real-time streaming recordings assessed LFP dynamics during stimulation ON/OFF conditions. Longitudinal at-home recordings were collected during the first postoperative month.

Results: Preoperative Burke-Fahn–Marsden Dystonia Rating Scale (BFMDRS) scores were motor 88.5/120 and disability 15/29. Survey recordings identified a low-alpha peak (8.8 Hz) in the left GPi and a low-beta peak (13.6 Hz) in the right GPi, guiding stimulation programming. Streaming recordings showed increased right GPi beta activity after stimulation cessation, whereas the left GPi showed minimal changes. At one-month follow-up, clinical improvement was observed (BFMDRS motor 74.5/120; disability 13/29). Follow-up survey showed suppression of the alpha peak in the left GPi and beta peak in the right GPi. Streaming confirmed suppression of the 13 Hz beta activity during stimulation and absence of beta rebound after bilateral stimulation cessation. Longitudinal recordings showed progressive reduction of overall LFP activity with nocturnal intra- and inter-hemispheric synchronization.

Conclusion: This case report demonstrates the feasibility of chronic pallidal LFP sensing in acquired dystonia secondary to kernicterus. Progressive suppression of pathological oscillations paralleled clinical changes, supporting their potential role as neurophysiological biomarkers for GPi DBS and highlighting opportunities for biomarker-guided neuromodulation in dystonia.

References: 1) Meoni S., Fraix V., Castrioto A. et al., Pallidal deep brain stimulation for dystonia: a long term study. J Neurol Neurosurg Psychiatry, 2017. 88(11): 960-967.
2) Ledingham D., Baker M., Pavese N. Local field potentials: Therapeutic implications for DBS in dystonia including adaptive DBS for dystonia. Deep Brain Stimulation, 2024. 5: 4-19.
3) Thenaisie Y., Palmisano C., Canessa A. et al., Towards adaptive deep brain stimulation: clinical and technical notes on a novel commercial device for chronic brain sensing. J Neural Eng, 2021. 18(4).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pallidal-local-field-potentials-modulation-by-deep-brain-stimulation-in-acquired-dystonia-due-to-kernicterus/