Low-frequency oscillation suppression in dystonia: Implications for adaptive deep brain stimulation

D Piña-Fuentes; M Beudel; J C Van Zijl; M E Van Egmond; D L M Oterdoom; J M C Van Dijk; M A J Tijssen

doi:10.1016/j.parkreldis.2020.08.030

Low-frequency oscillation suppression in dystonia: Implications for adaptive deep brain stimulation

Parkinsonism Relat Disord. 2020 Oct:79:105-109. doi: 10.1016/j.parkreldis.2020.08.030. Epub 2020 Aug 23.

Authors

D Piña-Fuentes¹, M Beudel², J C Van Zijl³, M E Van Egmond⁴, D L M Oterdoom⁵, J M C Van Dijk⁵, M A J Tijssen³

Affiliations

¹ University of Groningen, University Medical Center Groningen, Department of Neurosurgery, Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands. Electronic address: d.a.i.pina.fuentes@umcg.nl.
² Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands.
³ Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands.
⁴ Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands; Ommelander Ziekenhuis Groningen, Department of Neurology, Scheemda, the Netherlands.
⁵ University of Groningen, University Medical Center Groningen, Department of Neurosurgery, Groningen, the Netherlands.

PMID: 32919097
DOI: 10.1016/j.parkreldis.2020.08.030

Abstract

Background: Low-frequency oscillations (LFO) detected in the internal globus pallidus of dystonia patients have been identified as a physiomarker for adaptive Deep Brain Stimulation (aDBS), since LFO correlate with dystonic symptoms and are rapidly suppressed by continuous DBS (cDBS). However, it is as yet unclear how LFO should be incorporated as feedback for aDBS.

Objectives: to test the acute effects of aDBS, using the amplitude of short-lived LFO-bursts to titrate stimulation, to explore the immediate effects of cDBS on LFO-modulation and dystonic symptoms, and to investigate whether a difference in the resting-state LFO is present between DBS-naïve patients and patients with chronic DBS.

Methods: seven patients were assessed during either DBS-implantation (n = 2) or battery replacement surgery (n = 5), and pseudorandomized in three conditions: no stimulation, cDBS, and aDBS. Additionally, resting-state LFP-recordings from patients undergoing battery replacement were compared to those obtained during DBS-implantation; LFP-recordings from a previous cohort of six dystonia patients undergoing DBS-implantation were incorporated into this analysis (total n = 8 newly implanted patients).

Results: we corroborated that a mild LFO-suppression rapidly occurs during cDBS. However, no acute changes in clinical symptoms were observed after cDBS or aDBS. Remarkably, we observed that resting-state LFO were significantly lower in patients who had been effectively treated with chronic cDBS compared to those of newly implanted patients, even when stimulation was suspended.

Conclusions: our results indicate that LFO-suppression in dystonia, similar to symptom response to cDBS, might be gradual, and remain after stimulation is suspended. Therefore, tracking gradual changes in LFO may be required for aDBS implementation.

Keywords: Adaptive deep brain stimulation; Closed-loop; Dystonia; Internal globus pallidus; Local field potentials; Low-frequency oscillations.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Brain Waves / physiology*
Deep Brain Stimulation* / methods
Deep Brain Stimulation* / standards
Dystonia / physiopathology*
Dystonia / therapy*
Dystonic Disorders / physiopathology*
Dystonic Disorders / therapy*
Female
Globus Pallidus*
Humans
Male
Middle Aged