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Abstracts
003 Subthalamic nucleus deep brain stimulation evoked resonant neural activity predicts clinical response to DBS
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  1. San San Xu1,3,2,
  2. Nicholas C Sinclair1,2,
  3. Kristian J Bulluss1,4,5,
  4. Thushara Perera1,2,
  5. Wee-Lih Lee1,2,
  6. Hugh J McDermott1,2,
  7. Wesley Thevathasan1,3,6,7
  1. 1Bionics Institute, East Melbourne, VIC, Australia
  2. 2Department of Medical Bionics, The University of Melbourne, Parkville, VIC, Australia
  3. 3Department of Neurology, Austin Hospital, Heidelberg, VIC, Australia
  4. 4Department of Neurosurgery, Austin Hospital, Heidelberg, VIC, Australia
  5. 5Department of Neurosurgery, St Vincent’s Hospital, Fitzroy, VIC, Australia
  6. 6Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
  7. 7Department of Medicine, The University of Melbourne, Parkville, VIC, Australia

Abstract

Introduction DBS can improve motor deficit in Parkinson’s disease (PD) patients. Existing devices have limitations due to electrode positioning errors, fallible manual programming and delivery of continuous ‘open-loop’ stimulation despite fluctuating patient state. This results in partial efficacy, adverse effects and increased cost. One solution is to use an electrical feedback signal or ‘biomarker’ recorded from DBS electrodes. The most widely studied signal has been spontaneous local field potentials (LFPs), particularly beta band (13–30 Hz) and high frequency oscillations (HFO) (200–400 Hz). Here, we report a novel biomarker in the form of a large amplitude, evoked potential, with a characteristic oscillatory decay, termed evoked resonant neural activity (ERNA).1

Methods LFPs and ERNA were recorded in 14 patients with PD (28 hemispheres) undergoing STN DBS surgery. The four contacts in each electrode array were ranked according to ERNA amplitude, beta power, HFO power and proximity to the anatomically ideal stimulation location. At least 3 months after surgery, motor scores (UPDRS III, reaction time) were evaluated off-DBS and during stimulation delivered through each electrode contact in a randomised order.

Results ERNA amplitude, beta power and contact proximity to the anatomically ideal stimulation location predicted magnitude of therapeutic response to DBS. However, after exclusion of covariance, ERNA amplitude remained the only significant predictor of DBS response.

Conclusion ERNA is a readily recordable, large amplitude signal that accurately correlates with motor response to DBS. It holds significant potential as a biomarker for guiding electrode implantation, ideal contact selection, automated parameter fitting and delivery of closed-loop DBS.

Reference

  1. Sinclair NC, McDermott HJ, Bulluss KJ, Fallon JB, Perera T, Xu SS, et al. Subthalamic nucleus deep brain stimulation evokes resonant neural activity. Annals of neurology 2018;83(5).

https://doi.org/10.1136/jnnp-2019-anzan.3

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