Combining Multimodal Biomarkers to Guide Deep Brain Stimulation Programming in Parkinson Disease

Ashesh Shah, Thuy-Anh KhoaNguyen, Katrin Peterman, Saed Khawaldeh, Ines Debove, Syed Ahmar Shah, Flavie Torrecillos, Huiling Tan, Alex Pogosyan, Martin Lachenmayer, Joan Michelis, Peter Brown, Claudio Pollo, Paul Krack, Andreas Nowacki, Gerd Tinkhauser

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Deep brain stimulation (DBS) programming of multicontact DBS leads relies on a very time-consuming manual screening procedure, and strategies to speed up this process are needed. Beta activity in subthalamic nucleus (STN) local field potentials (LFP) has been suggested as a promising marker to index optimal stimulation contacts in patients with Parkinson disease.

Objective
In this study, we investigate the advantage of algorithmic selection and combination of multiple resting and movement state features from STN LFPs and imaging markers to predict three relevant clinical DBS parameters (clinical efficacy, therapeutic window, side-effect threshold).

Materials and Methods
STN LFPs were recorded at rest and during voluntary movements from multicontact DBS leads in 27 hemispheres. Resting- and movement-state features from multiple frequency bands (alpha, low beta, high beta, gamma, fast gamma, high frequency oscillations [HFO]) were used to predict the clinical outcome parameters. Subanalyses included an anatomical stimulation sweet spot as an additional feature.

Results
Both resting- and movement-state features contributed to the prediction, with resting (fast) gamma activity, resting/movement-modulated beta activity, and movement-modulated HFO being most predictive. With the proposed algorithm, the best stimulation contact for the three clinical outcome parameters can be identified with a probability of almost 90% after considering half of the DBS lead contacts, and it outperforms the use of beta activity as single marker. The combination of electrophysiological and imaging markers can further improve the prediction.

Conclusion
LFP-guided DBS programming based on algorithmic selection and combination of multiple electrophysiological and imaging markers can be an efficient approach to improve the clinical routine and outcome of DBS patients.
Original languageEnglish
JournalNeuromodulation
DOIs
Publication statusPublished - 24 Feb 2022

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