Local Field Potential-Based Programming: A Proof-of-Concept Pilot Study

Alfonso Fasano; Carolina Gorodetsky; Darcia Paul; Jürgen Germann; Aaron Loh; Han Yan; Peter L Carlen; Sara Breitbart; Andres M Lozano; George M Ibrahim; Suneil K Kalia

doi:10.1111/ner.13520

Local Field Potential-Based Programming: A Proof-of-Concept Pilot Study

Neuromodulation. 2022 Feb;25(2):271-275. doi: 10.1111/ner.13520.

Authors

Affiliations

¹ Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada; Division of Neurology, University of Toronto, Toronto, ON, Canada; Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada; KITE, University Health Network, Toronto, ON, Canada. Electronic address: alfonso.fasano@uhn.ca.
² Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada; Division of Neurology, University of Toronto, Toronto, ON, Canada; Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada.
³ Division of Neurosurgery, University of Toronto, Toronto, ON, Canada.
⁴ Krembil Brain Institute, University Health Network, Toronto, ON, Canada.
⁵ Division of Neurology, University of Toronto, Toronto, ON, Canada; Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Epilepsy Program, Toronto Western Hospital, UHN, Toronto, ON, Canada.
⁶ Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Division of Neurosurgery, University of Toronto, Toronto, ON, Canada.
⁷ Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada; Division of Neurosurgery, University of Toronto, Toronto, ON, Canada.
⁸ Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada; KITE, University Health Network, Toronto, ON, Canada; Division of Neurosurgery, University of Toronto, Toronto, ON, Canada.

PMID: 35125146
DOI: 10.1111/ner.13520

Abstract

Objectives: Programming deep brain stimulation (DBS) is still based on a trial-and-error approach, often becoming a time-consuming process for both treating physicians and patients. Several strategies have been proposed to streamline DBS programming, most of which are preliminary and mainly address Parkinson's disease, a condition readily responsive to DBS adjustments. In the present proof-of-principle pilot study, we successfully demonstrate that local field potential (LFP)-based programming can be an effective approach when used for DBS indications that have a delayed temporal onset of benefit.

Materials and methods: A recently commercialized implantable pulse generator (IPG) with the capability to non-invasively and chronically stream live and/or record LFPs from a DBS electrode after implantation was used to program one pediatric patient with generalized dystonia and an adult with seizures refractory to multiple medications and vagal nerve stimulation.

Results: The IPG survey function detected a peak in the delta range (1.95 Hz) in the left globus pallidus of the first patient. This LFP was detected when recording in the brain area adjacent to contacts 9 and 10 and absent when recording from other areas. The chronic recording of the 1.95 Hz LFP with two sets of stimulation showed a greater power increase with the settings associated with a worsening of dystonia. Broadband LFP home recording of "absence seizure" and "focal/partial seizure" was used in the second patient and reviewer with the IPG "timeline" and "event" functions. The chronic recording of the 2.93 Hz and 8.79 Hz (spit sensing) showed a reduced power with the stimulation setting associated with seizure control.

Conclusions: The approach presented in this pilot proof-of-concept study may inform and streamline the DBS programming for conditions requiring clinicians and patients to wait weeks before appreciating any clinical benefit. Prospective studies on larger samples of patients are warranted.

Keywords: Deep brain stimulation; local field potential; neuromodulation; percept; programming.

MeSH terms

Adult
Child
Deep Brain Stimulation*
Globus Pallidus
Humans
Parkinson Disease* / therapy
Pilot Projects
Prospective Studies