Unipolar recordings of beta power inform initial programming of the subthalamic nucleus in Parkinson's disease.

BACKGROUND

Optimizing deep brain stimulation (DBS) programming in Parkinson's disease (PD) requires a complex process for evaluating clinical benefit and adverse effects. Localizing maximum beta (13-30Hz) power may guide DBS programming. Novel use of in-clinic unipolar recording may improve the efficacy of neurophysiology-guided DBS programming.

OBJECTIVE

Compare the contact selection and clinical outcomes based upon either maximum beta power from unipolar recordings or standard-of-care monopolar review at initial programming in PD.

METHODS

Ten PD patients (4F/6M, post-diagnosis = 9.2 ± 3.5 years; on/off percent change = 43.7 ± 14.0) with bilateral subthalamic nucleus (STN) DBS were recruited. For each hemisphere, contacts selected by maximum beta power from unipolar recordings or monopolar clinical assessments were compared based upon therapeutic window (TW), MDS-UPDRS Part III for unilateral symptoms, and the time to complete these two conditions.

RESULTS

Change from baseline in TW and MDS-UPDRS Part III outcomes did not differ between DBS programming based upon unipolar recordings and monopolar review, nor were there differences in sub-analysis for bradykinesia, rigidity, and tremor. Time efficiency in contact selection was greater for unipolar recordings compared with monopolar assessment (p = 3.6e-15). Follow-up comparison between unipolar and bipolar recordings to determine the location of maximum beta power revealed that 85% of the unipolar contacts were one of the bipolar recording pairs.

CONCLUSION

This study further supports the use of neurophysiology, specifically unipolar recordings of beta power, to inform initial programming with evidence of efficiency and clinical efficacy.