The impact of pulse timing on cortical and subthalamic nucleus deep brain stimulation evoked potentials

Brett A Campbell; Leonardo Favi Bocca; David Escobar Sanabria; Julio Almeida; Richard Rammo; Sean J Nagel; Andre G Machado; Kenneth B Baker

doi:10.3389/fnhum.2022.1009223

The impact of pulse timing on cortical and subthalamic nucleus deep brain stimulation evoked potentials

Front Hum Neurosci. 2022 Sep 20:16:1009223. doi: 10.3389/fnhum.2022.1009223. eCollection 2022.

Authors

Brett A Campbell^{1

2}, Leonardo Favi Bocca³, David Escobar Sanabria⁴, Julio Almeida³, Richard Rammo^{3

5}, Sean J Nagel^{3

5}, Andre G Machado^{2

3

5}, Kenneth B Baker^{2

3}

Affiliations

¹ Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States.
² Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.
³ Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
⁴ Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.
⁵ Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.

Abstract

The impact of pulse timing is an important factor in our understanding of how to effectively modulate the basal ganglia thalamocortical (BGTC) circuit. Single pulse low-frequency DBS-evoked potentials generated through electrical stimulation of the subthalamic nucleus (STN) provide insight into circuit activation, but how the long-latency components change as a function of pulse timing is not well-understood. We investigated how timing between stimulation pulses delivered in the STN region influence the neural activity in the STN and cortex. DBS leads implanted in the STN of five patients with Parkinson's disease were temporarily externalized, allowing for the delivery of paired pulses with inter-pulse intervals (IPIs) ranging from 0.2 to 10 ms. Neural activation was measured through local field potential (LFP) recordings from the DBS lead and scalp EEG. DBS-evoked potentials were computed using contacts positioned in dorsolateral STN as determined through co-registered post-operative imaging. We quantified the degree to which distinct IPIs influenced the amplitude of evoked responses across frequencies and time using the wavelet transform and power spectral density curves. The beta frequency content of the DBS evoked responses in the STN and scalp EEG increased as a function of pulse-interval timing. Pulse intervals <1.0 ms apart were associated with minimal to no change in the evoked response. IPIs from 1.5 to 3.0 ms yielded a significant increase in the evoked response, while those >4 ms produced modest, but non-significant growth. Beta frequency activity in the scalp EEG and STN LFP response was maximal when IPIs were between 1.5 and 4.0 ms. These results demonstrate that long-latency components of DBS-evoked responses are pre-dominantly in the beta frequency range and that pulse interval timing impacts the level of BGTC circuit activation.

Keywords: Parkinson' disease; beta; deep brain stimulation; evoked potentials; pulse timing.