Low-frequency oscillation suppression in dystonia: Implications for adaptive deep brain stimulation

• Published in: Parkinsonism & related disorders Vol. 79; pp. 105 - 109
• Main Authors: Piña-Fuentes, D., Beudel, M., Van Zijl, J.C., Van Egmond, M.E., Oterdoom, D.L.M., Van Dijk, J.M.C., Tijssen, M.A.J.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-10-2020
• Subjects: Adaptive deep brain stimulation; Aged; Aged, 80 and over; Brain Waves - physiology; Closed-loop; Deep Brain Stimulation - methods; Deep Brain Stimulation - standards; Dystonia; Dystonia - physiopathology; Dystonia - therapy; Dystonic Disorders - physiopathology; Dystonic Disorders - therapy; Female; Globus Pallidus; Humans; Internal globus pallidus; Local field potentials; Low-frequency oscillations; Male; Middle Aged; Internal globus pallidus; Dystonia; Adaptive deep brain stimulation; Low-frequency oscillations; Local field potentials; Closed-loop
• ISSN: 1353-8020; 1873-5126
• DOI: 10.1016/j.parkreldis.2020.08.030

Low-frequency oscillations (LFO) detected in the internal globus pallidus of dystonia patients have been identified as a physiomarker for adaptive Deep Brain Stimulation (aDBS), since LFO correlate with dystonic symptoms and are rapidly suppressed by continuous DBS (cDBS). However, it is as yet unclear how LFO should be incorporated as feedback for aDBS.
to test the acute effects of aDBS, using the amplitude of short-lived LFO-bursts to titrate stimulation, to explore the immediate effects of cDBS on LFO-modulation and dystonic symptoms, and to investigate whether a difference in the resting-state LFO is present between DBS-naïve patients and patients with chronic DBS.
seven patients were assessed during either DBS-implantation (n = 2) or battery replacement surgery (n = 5), and pseudorandomized in three conditions: no stimulation, cDBS, and aDBS. Additionally, resting-state LFP-recordings from patients undergoing battery replacement were compared to those obtained during DBS-implantation; LFP-recordings from a previous cohort of six dystonia patients undergoing DBS-implantation were incorporated into this analysis (total n = 8 newly implanted patients).
we corroborated that a mild LFO-suppression rapidly occurs during cDBS. However, no acute changes in clinical symptoms were observed after cDBS or aDBS. Remarkably, we observed that resting-state LFO were significantly lower in patients who had been effectively treated with chronic cDBS compared to those of newly implanted patients, even when stimulation was suspended.
our results indicate that LFO-suppression in dystonia, similar to symptom response to cDBS, might be gradual, and remain after stimulation is suspended. Therefore, tracking gradual changes in LFO may be required for aDBS implementation.
•A mild low-frequency oscillation (LFO) suppression in dystonia directly follows cDBS.•Changes in dystonic symptoms might not occur directly after stimulation delivery.•Patients with chronic cDBS present significantly lower LFO than DBS-naïve patients.•LFO-suppression in dystonia, similar to symptom response to cDBS, might be gradual.•aDBS could be programmed to track gradual changes in background LFO-power.