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

Shah SA
Nguyen TAK
Petermann K
Khawaldeh S
Debove I
Shah SA
Torrecillos F
Tan H
Pogosyan A
Lachenmayer ML
Michelis J
Brown P
Pollo C
Krack P
Nowacki A
Tinkhauser G

After deep brain stimulation (DBS) surgery for Parkinson’s, stimulation settings must be optimised with programming to best manage patients’ symptoms. Currently, DBS stimulation programming is a manual and time-consuming procedure. Here, we used an algorithm and different information (brain signals, imaging data and clinical evaluations) to predict the most relevant DBS settings. This method should help automate and facilitate DBS programming in the future.

Scientific 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.

At the top, there are three cartoons of a Deep Brain Stimulation lead with eight contacts. At the bottom, there are coloured graphs showing different kinds of neuronal activity.
A. Multi-contact Deep Brain Stimulation Lead (Boston Scientific). B. Resting state power- and movement-related modulation of subthalamic nucleus activity in selected frequency bands that were used for prediction of lead contacts.
2022. Neuromodulation, Feb 23: in press.
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