Objective: To observe chronically recorded local field potentials (LFPs) in patients receiving Deep Brain Stimulation (DBS) for Parkinson’s Disease (PD) and using an adaptive DBS (aDBS) algorithm both in and out of the clinic.

Background: In properly selected patients, DBS is an effective therapy to alleviate motor symptoms of PD. Recent technological advances enable to further personalize DBS using specific LFP frequency bands recorded by an implantable neurostimulator (INS) via the DBS leads. The INS then adjusts stimulation based on variations in LFP power, within limits set by the physician.

Method: We conducted a retrospective chart and data review of three PD patients who were implanted bilaterally with DBS leads targeting the subthalamic nucleus and connected to an INS capable of recording LFPs and delivering aDBS. LFP oscillations in the beta band (8-30 Hz) were chronically recorded and stored in the INS first during continuous DBS (cDBS), both in and out of the clinic, in a “real world” setting. The INS was later switched to aDBS, adjusting the stimulation amplitude according to the patients’ beta power using a dual-threshold algorithm, both in and out of the clinic. Medications were adjusted throughout the LFP recording phases according to the patients’ needs.

Results: All patients responded well to cDBS before aDBS set-up. Strength of beta signal varied from patient to patient, hemisphere to hemisphere, and responded to stimulation amplitude adjustments, either manually during cDBS, or automatically using the aDBS algorithm. Furthermore, circadian rhythms were identified, with reduction in beta power during the night.  Individual differences in these circadian rhythms point to the need for adjustments of stimulation to be driven by the patient’s own brain signals, reflecting their lifestyle and activity patterns, rather than arbitrary times of the day.

Conclusion: Meaningful LFPs could be recorded chronically and used to drive aDBS using a dual-threshold algorithm. New challenges include identifying the optimal peak frequency and optimal time to start aDBS for each patient. Furthermore, randomized controlled trials will be required to assess and compare the safety, efficacy and power usage of aDBS versus cDBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/personalization-of-deep-brain-stimulation-using-local-field-potentials-to-drive-adaptive-dbs-a-case-series/