Pseudo-monopolar sensing of subthalamic beta power helps to predict optimal DBS contacts in Parkinson’s Disease

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Abstract Background Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for Parkinson’s Disease (PD), but identifying optimal stimulation contacts is time-intensive. Beta- band activity (13-35 Hz) from local field potentials (LFP) correlates with motor symptoms and attenuation by dopaminergic therapy and DBS supports its role as a programming biomarker. The recently introduced Electrode Identifier (EI) feature of Medtronic Percept TM neurostimulators may facilitate beta-guided contact selection. Objective To evaluate whether pseudo-monopolar STN beta power obtained using EI predicts optimal stimulation contacts and compare its performance with reconstructed bipolar recordings and MPR. Methods LFPs were recorded in 69 patients using EI and Electrode Survey (ES). Prediction accuracy was assessed using predefined ranking rules and compared with clinically selected contacts. Agreement between EI, ES, and MPR was evaluated. Motor outcome was assessed using MDS-UPDRS-III. Results EI predicted clinically selected contacts above chance (TOP1: 45%, p = 0.010; TOP2-80: 57%, p = <0.001), whereas ES exceeded chance only under more inclusive selection criteria (TOP1: 38%, p = 0.073; TOP2-80: 55%, p = 0.0021). Accuracy did not differ between methods (TOP1: p = 0.720; TOP2-80: p = 1.000). EI showed highest agreement with MPR and tended to select ventral contacts. Neither method predicted motor outcome, although EI-matched contacts showed a trend toward greater improvement. Due to technical constraints, one-third of EI recordings were excluded. Conclusions Pseudo-monopolar STN beta power provides clinically relevant information for DBS contact selection with performance comparable to bipolar approaches. Further improvements are needed before clinical implementation.

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