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Long-term directional deep brain stimulation: Monopolar review vs. local field potential guided programming.
Carla Fernández-García1, Mariana H G Monje2, Víctor Gómez-Mayordomo3
1Department of Neurosurgery, Hospital Clínico San Carlos, San Carlos Research Health Institute (IdISSC), Madrid, Spain; Universidad Complutense, Madrid, Spain, Madrid, Spain.
Brain Stimulation
|May 1, 2022
Summary
Intraoperative beta oscillations effectively guide directional subthalamic stimulation in Parkinson's disease, improving therapeutic windows and achieving similar long-term outcomes compared to traditional methods.
Area of Science:
- Neuroscience
- Neurosurgery
- Biomedical Engineering
Background:
- Directional subthalamic stimulation (DTS) in Parkinson's disease (PD) aims to optimize therapeutic outcomes.
- Programming DTS settings is complex and time-consuming, often requiring extensive monopolar reviews.
- Intraoperative local field potential (LFP) beta oscillations (13-35 Hz) offer a potential method to streamline programming.
Purpose of the Study:
- To determine if intraoperative LFP beta oscillation power predicts optimal directional stimulation contacts in PD.
- To compare long-term outcomes of DTS programmed using beta oscillations versus conventional monopolar review.
Main Methods:
- A prospective, non-randomized study involving 24 Parkinson's disease patients.
- Group A (n=14): DTS programmed via clinical monopolar review (27-month follow-up).
- Group B (n=10): DTS programmed using intraoperative beta oscillation analysis (13-month follow-up).
Main Results:
- A strong correlation was found between clinical efficacy and the low-beta sub-band of LFP oscillations.
- Highest beta peaks identified contacts that increased the therapeutic window by 25%.
- Programming based on beta activity yielded comparable long-term motor improvements (72% reduction) and medication reduction (63-65%) in both groups.
Conclusions:
- Intraoperative LFP beta oscillations are a validated tool for guiding DTS programming in Parkinson's disease.
- This neurophysiological approach enhances programming efficiency while maintaining long-term clinical efficacy.
- Beta oscillation-guided programming offers a reliable alternative to traditional methods for optimizing DTS parameters.
