Bilateral Double Beta Oscillations in Parkinson’s Disease with STN Electrodes
Overview
This report describes a Parkinson’s disease patient exhibiting two distinct beta-band peaks bilaterally in subthalamic nucleus local field potentials (LFPs). These double beta oscillations were modulated differently by deep brain stimulation (DBS) and gait, with stimulation suppressing peaks on the left side but inducing a novel low-frequency peak on the right.
Background
Beta-band oscillations (13–30 Hz) in subthalamic nucleus LFPs correlate with Parkinson’s disease motor symptoms such as bradykinesia and respond to treatments like l-Dopa and DBS. Historically, long-term LFP recordings were limited by device capabilities. The Medtronic Percept™ implantable pulse generator enables chronic LFP monitoring, allowing detailed assessment of beta oscillations and their modulation by stimulation and movement. Understanding these oscillations may improve DBS optimization and symptom management.
Data Highlights
Parameter
Left STN
Right STN
Beta Peaks (Hz)
15, 25
15, 25 (intraop), 13 (stim-induced)
UPDRS III Scores
Stim off: 38; Med on: 16; Stim on, Med off: 7
Effect of Stimulation on Beta Peaks
Gradual reduction of both peaks with increasing amplitude
Reduction of 25 Hz peak; 15 Hz peak replaced by 13 Hz peak at higher amplitudes
Effect of Gait on Beta Peaks
Near complete suppression during gait without stimulation
Partial suppression during gait with stimulation; additional 13 Hz peak present
Key Findings
Intraoperative LFPs showed one beta peak on the left STN and two distinct peaks on the right STN.
Chronic recordings revealed bilateral double beta peaks at ~15 Hz and ~25 Hz suppressed by stimulation on the left side.
On the right side, stimulation suppressed the 25 Hz peak but induced a novel low beta peak at 13 Hz.
Gait suppressed beta peaks more completely on the left side than on the right, where partial suppression and the 13 Hz peak persisted.
Real-time stimulator analysis of beta peaks (20–30 Hz) missed the low-frequency 13 Hz peak induced by stimulation.
UPDRS III motor scores improved markedly with stimulation, correlating with modulation of beta oscillations.
Clinical Implications
The presence of bilateral double beta peaks and their differential modulation by DBS and gait highlight the complexity of STN beta oscillations in Parkinson’s disease. Clinicians should consider that stimulation may induce novel low-frequency oscillations not captured by standard beta-band analyses, potentially influencing symptom control. Continuous LFP monitoring with advanced devices can guide personalized DBS programming to optimize therapeutic outcomes.
Conclusion
This case demonstrates that bilateral double beta oscillations in the STN can be differentially modulated by DBS and gait, with stimulation sometimes inducing novel low-frequency peaks. These findings underscore the value of chronic LFP recordings for understanding and optimizing DBS effects in Parkinson’s disease.
References
Article Source 2024 -- Bilateral Double Beta Oscillations Observed in a Parkinson's Disease Patient with Subthalamic Nucleus Electrodes
