Long-term directional deep brain stimulation: Monopolar review vs. local field potential guided programming
Background: Directional subthalamic stimulation in Parkinson's disease can increase stimulation threshold for adverse effects and widen the therapeutic window. However, selection of programming settings is time consuming, requiring a thorough monopolar clinical review. To overcome this, program...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-05-01
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| Series: | Brain Stimulation |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1935861X22000754 |
| _version_ | 1811341709028622336 |
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| author | Carla Fernández-García Mariana H.G. Monje Víctor Gómez-Mayordomo Guglielmo Foffani Rafael Herranz Maria José Catalán Mercedes González-Hidalgo Jorge Matias-Guiu Fernando Alonso-Frech |
| author_facet | Carla Fernández-García Mariana H.G. Monje Víctor Gómez-Mayordomo Guglielmo Foffani Rafael Herranz Maria José Catalán Mercedes González-Hidalgo Jorge Matias-Guiu Fernando Alonso-Frech |
| author_sort | Carla Fernández-García |
| collection | DOAJ |
| description | Background: Directional subthalamic stimulation in Parkinson's disease can increase stimulation threshold for adverse effects and widen the therapeutic window. However, selection of programming settings is time consuming, requiring a thorough monopolar clinical review. To overcome this, programming may be guided by intraoperatively recording local field potential beta oscillations (13–35 Hz). Objectives: 1) Evaluate whether the power of beta oscillations recorded intraoperatively can predict the clinically most effective directional contacts; and 2) assess long-term directional stimulation outcomes between patients programmed based on clinical monopolar review and patients programmed based on beta activity. Methods: We conducted a non-randomized, prospective study with 24 Parkinson's disease patients divided into two groups. In group A (14 patients, 2016–2018), we investigated whether beta activity in the directional contacts correlated with clinical efficacy. Stimulating parameters were selected according to clinical monopolar review and mean follow-up was 27 months. In group B (10 patients, 2018–2019), stimulating parameters were selected according to beta activity and mean follow-up was 13 months. Results: Neurophysiological results showed a strong correlation between clinical efficacy and the low-beta sub-band. Contacts with highest beta peaks increased the therapeutic window by 25%. Selecting the two contacts with highest beta peaks provided an 82% probability of selecting the best clinical contact. Clinical results showed similar improvements in group A (motor score, 72% reduction; levodopa-equivalent daily dose, 65% reduction) and B (72% and 63% reduction, respectively), maintained at long-term follow-up. Conclusions: Our results validate the long-term efficacy of directional stimulation guided by intraoperative local field potential beta oscillations. |
| first_indexed | 2024-04-13T18:57:56Z |
| format | Article |
| id | doaj.art-1e908f019b0d4c9da8603a85f9b7e5a4 |
| institution | Directory Open Access Journal |
| issn | 1935-861X |
| language | English |
| last_indexed | 2024-04-13T18:57:56Z |
| publishDate | 2022-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain Stimulation |
| spelling | doaj.art-1e908f019b0d4c9da8603a85f9b7e5a42022-12-22T02:34:10ZengElsevierBrain Stimulation1935-861X2022-05-01153727736Long-term directional deep brain stimulation: Monopolar review vs. local field potential guided programmingCarla Fernández-García0Mariana H.G. Monje1Víctor Gómez-Mayordomo2Guglielmo Foffani3Rafael Herranz4Maria José Catalán5Mercedes González-Hidalgo6Jorge Matias-Guiu7Fernando Alonso-Frech8Department of Neurosurgery, Hospital Clínico San Carlos, San Carlos Research Health Institute (IdISSC), Madrid, Spain; Universidad Complutense, Madrid, Spain, Madrid, SpainHM CINAC, Hospital Universitario HM Puerta Del Sur, Universidad CEU–San Pablo, Móstoles, Madrid, SpainDepartment of Neurology, Hospital Clínico San Carlos, San Carlos Research Health Institute (IdISSC), Madrid, SpainHM CINAC, Hospital Universitario HM Puerta Del Sur, Universidad CEU–San Pablo, Móstoles, Madrid, SpainDepartment of Epidemiology, Hospital Clínico San Carlos, San Carlos Research Health Institute (IdISSC), Madrid, SpainDepartment of Neurology, Hospital Clínico San Carlos, San Carlos Research Health Institute (IdISSC), Madrid, SpainDepartment of Neurophysiology, Hospital Clínico San Carlos, San Carlos Research Health Institute (IdISSC), Madrid, SpainUniversidad Complutense, Madrid, Spain, Madrid, Spain; Department of Neurology, Hospital Clínico San Carlos, San Carlos Research Health Institute (IdISSC), Madrid, SpainDepartment of Neurology, Hospital Clínico San Carlos, San Carlos Research Health Institute (IdISSC), Madrid, Spain; Corresponding author. Neuroscience Institute, Hospital Clínico San Carlos, C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain.Background: Directional subthalamic stimulation in Parkinson's disease can increase stimulation threshold for adverse effects and widen the therapeutic window. However, selection of programming settings is time consuming, requiring a thorough monopolar clinical review. To overcome this, programming may be guided by intraoperatively recording local field potential beta oscillations (13–35 Hz). Objectives: 1) Evaluate whether the power of beta oscillations recorded intraoperatively can predict the clinically most effective directional contacts; and 2) assess long-term directional stimulation outcomes between patients programmed based on clinical monopolar review and patients programmed based on beta activity. Methods: We conducted a non-randomized, prospective study with 24 Parkinson's disease patients divided into two groups. In group A (14 patients, 2016–2018), we investigated whether beta activity in the directional contacts correlated with clinical efficacy. Stimulating parameters were selected according to clinical monopolar review and mean follow-up was 27 months. In group B (10 patients, 2018–2019), stimulating parameters were selected according to beta activity and mean follow-up was 13 months. Results: Neurophysiological results showed a strong correlation between clinical efficacy and the low-beta sub-band. Contacts with highest beta peaks increased the therapeutic window by 25%. Selecting the two contacts with highest beta peaks provided an 82% probability of selecting the best clinical contact. Clinical results showed similar improvements in group A (motor score, 72% reduction; levodopa-equivalent daily dose, 65% reduction) and B (72% and 63% reduction, respectively), maintained at long-term follow-up. Conclusions: Our results validate the long-term efficacy of directional stimulation guided by intraoperative local field potential beta oscillations.http://www.sciencedirect.com/science/article/pii/S1935861X22000754Beta oscillationsDirectional deep brain stimulationLocal field potentialsParkinson's diseaseSubthalamic nucleus |
| spellingShingle | Carla Fernández-García Mariana H.G. Monje Víctor Gómez-Mayordomo Guglielmo Foffani Rafael Herranz Maria José Catalán Mercedes González-Hidalgo Jorge Matias-Guiu Fernando Alonso-Frech Long-term directional deep brain stimulation: Monopolar review vs. local field potential guided programming Brain Stimulation Beta oscillations Directional deep brain stimulation Local field potentials Parkinson's disease Subthalamic nucleus |
| title | Long-term directional deep brain stimulation: Monopolar review vs. local field potential guided programming |
| title_full | Long-term directional deep brain stimulation: Monopolar review vs. local field potential guided programming |
| title_fullStr | Long-term directional deep brain stimulation: Monopolar review vs. local field potential guided programming |
| title_full_unstemmed | Long-term directional deep brain stimulation: Monopolar review vs. local field potential guided programming |
| title_short | Long-term directional deep brain stimulation: Monopolar review vs. local field potential guided programming |
| title_sort | long term directional deep brain stimulation monopolar review vs local field potential guided programming |
| topic | Beta oscillations Directional deep brain stimulation Local field potentials Parkinson's disease Subthalamic nucleus |
| url | http://www.sciencedirect.com/science/article/pii/S1935861X22000754 |
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