Stimulation-related increases in power spectral density covary with clinical evidence of overstimulation during deep brain stimulation for pediatric dystonia

Madelyn Pascual, Pediatric Movement Disorders Program, Department of Neurology, Barrow Neurological Institute, Phoenix Children's, Phoenix, Arizona, USA.
Pritha Bisarad, Departments of Cellular & Molecular Medicine, Child Health, Neurology and Translational Neuroscience and Program in Genetics, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA.
James Kelbert, Departments of Cellular & Molecular Medicine, Child Health, Neurology and Translational Neuroscience and Program in Genetics, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA.
Sarah Chinander, Department of Rehabilitation Therapy, Phoenix Children's, Phoenix, Arizona, USA.
Rose Gelineau-Morel, Department of Neurology, Children's Mercy Medical Center, Kansas City, MO, USA.
Carolina Gorodetsky, Hospital for Sick Children, Toronto, Ontario, Canada.
Angela L. Hewitt, Department of Neurology, University of Rochester, Rochester, NY, USA.
Travis Larsh, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Nicole Lucente, Department of Rehabilitation Therapy, Phoenix Children's, Phoenix, Arizona, USA.
Jennifer O'Malley, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
Terrence D. Sanger, Department of Neurology, Children's Hospital of Orange County, Los Angeles, CA, USA.
Lauren van der Werf, Department of Rehabilitation Therapy, Phoenix Children's, Phoenix, Arizona, USA.
Jason S. Hauptman, Department of Neurosurgery, Barrow Neurological Institute, Phoenix Children's, Phoenix, Arizona, USA.
Francisco A. Ponce, Department of Neurosurgery, Barrow Neurological Institute, Dignity Health, Phoenix, Arizona, USA.
Michael C. Kruer, Pediatric Movement Disorders Program, Department of Neurology, Barrow Neurological Institute, Phoenix Children's, Phoenix, Arizona, USA.
John A. Thompson, Departments of Neurology & Neurosurgery, Anschutz Medical Campus, University of Colorado - Aurora, Aurora, Colorado, USA.

Document Type

Article

Abstract

BACKGROUND: Dystonia patients undergoing deep brain stimulation (DBS) often require individualized stimulation settings. While effective settings reduce dystonia, excessive stimulation can worsen symptoms. Assessing DBS effects during office visits is challenging, as clinical changes can be delayed hours to days. OBJECTIVES: We evaluated whether local field potentials (LFPs) could serve as an acute biomarker of excessive stimulation in dystonia patients. METHODS: Real-time LFP band power and dystonia severity were quantified and compared during sequential changes in stimulation amplitude. RESULTS: Dystonia worsening was temporally associated with clinically evident and statistically significant increases in LFP band power during in-office DBS programming sessions. CONCLUSIONS: Although increased LFP band power correlated with clear clinical worsening in these patients, we anticipate that not all patients with dystonia will have such immediate signs of worsening. Increased LFP band power during incremented stimulation amplitude may represent a biomarker for patients at-risk of manifesting delayed clinical worsening.

Publication Date

3-7-2025

Publication Title

medRxiv : the preprint server for health sciences

PubMed ID

40093213

Digital Object Identifier (DOI)

10.1101/2025.03.05.25322884

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