Characterizing the effects of deep brain stimulation with magnetoencephalography: A review

Simultaneous invasive and non-invasive recordings in humans: A novel Rosetta stone for deciphering brain activity

Simultaneous noninvasive and invasive electrophysiological recordings provide a unique opportunity to achieve a comprehensive understanding of human brain activity, much like a Rosetta stone for human neuroscience. In this review we focus on the increasingly-used powerful combination of intracranial electroencephalography (iEEG) with scalp electroencephalography (EEG) or magnetoencephalography (MEG). We first provide practical insight on how to achieve these technically challenging recordings. We then provide examples from clinical research on how simultaneous recordings are advancing our understanding of epilepsy. This is followed by the illustration of how human neuroscience and methodological advances could benefit from these simultaneous recordings. We conclude with a call for open data sharing and collaboration, while ensuring neuroethical approaches and argue that only with a true collaborative approach the promises of simultaneous recordings will be fulfilled.

Neurophysiological mechanisms of deep brain stimulation across spatiotemporal resolutions

Deep brain stimulation is a neuromodulatory treatment for managing the symptoms of Parkinson's disease and other neurological and psychiatric disorders. Electrodes are chronically implanted in disease-relevant brain regions and pulsatile electrical stimulation delivery is intended to restore neurocircuit function. However, the widespread interest in the application and expansion of this clinical therapy has preceded an overarching understanding of the neurocircuit alterations invoked by deep brain stimulation. Over the years, various forms of neurophysiological evidence have emerged which demonstrate changes to brain activity across spatiotemporal resolutions; from single neuron, to local field potential, to brain-wide cortical network effects. Though fruitful, such studies have often led to debate about a singular putative mechanism. In this Update we aim to produce an integrative account of complementary instead of mutually exclusive neurophysiological effects to derive a generalizable concept of the mechanisms of deep brain stimulation. In particular, we offer a critical review of the most common historical competing theories, an updated discussion on recent literature from animal and human neurophysiological studies, and a synthesis of synaptic and network effects of deep brain stimulation across scales of observation, including micro-, meso- and macroscale circuit alterations.

Technical and clinical considerations for electroencephalography-based biomarkers for major depressive disorder

Major depressive disorder (MDD) is a prevalent and debilitating psychiatric disease that leads to substantial loss of quality of life. There has been little progress in developing new MDD therapeutics due to a poor understanding of disease heterogeneity and individuals' responses to treatments. Electroencephalography (EEG) is poised to improve this, owing to the ease of large-scale data collection and the advancement of computational methods to address artifacts. This review summarizes the viability of EEG for developing brain-based biomarkers in MDD. We examine the properties of well-established EEG preprocessing pipelines and consider factors leading to the discovery of sensitive and reliable biomarkers.

Robust Removal of Slow Artifactual Dynamics Induced by Deep Brain Stimulation in Local Field Potential Recordings Using SVD-Based Adaptive Filtering

Deep brain stimulation (DBS) is widely used as a treatment option for patients with movement disorders. In addition to its clinical impact, DBS has been utilized in the field of cognitive neuroscience, wherein the answers to several fundamental questions underpinning the mechanisms of neuromodulation in decision making rely on the ways in which a burst of DBS pulses, usually delivered at a clinical frequency, i.e., 130 Hz, perturb participants' choices. It was observed that neural activities recorded during DBS were contaminated with large artifacts, which lasts for a few milliseconds, as well as a low-frequency (slow) signal (~1-2 Hz) that can persist for hundreds of milliseconds. While the focus of most of methods for removing DBS artifacts was on the former, the artifact removal capabilities of the slow signal have not been addressed. In this work, we propose a new method based on combining singular value decomposition (SVD) and normalized adaptive filtering to remove both large (fast) and slow artifacts in local field potentials, recorded during a cognitive task in which bursts of DBS were utilized. Using synthetic data, we show that our proposed algorithm outperforms four commonly used techniques in the literature, namely, (1) normalized least mean square adaptive filtering, (2) optimal FIR Wiener filtering, (3) Gaussian model matching, and (4) moving average. The algorithm's capabilities are further demonstrated by its ability to effectively remove DBS artifacts in local field potentials recorded from the subthalamic nucleus during a verbal Stroop task, highlighting its utility in real-world applications.

Relationship between brain activity, cognitive function, and sleep spiking activation in new-onset self-limited epilepsy with centrotemporal spikes

Objective

This study aimed to investigate the relationship between cognitive function sleep spiking activation and brain activity in self-limited epilepsy with centrotemporal spikes (SeLECTS).

Methods

We used spike-wave index (SWI), which means the percentage of the spike and slow wave duration to the total non-REM (NREM) sleep time, as the grouping standard. A total of 14 children with SeLECTS (SWI ≥ 50%), 21 children with SeLECTS (SWI < 50%), and 20 healthy control children were recruited for this study. Cognitive function was evaluated using the Wechsler Intelligence Scale for Children, Fourth Edition (Chinese version) (WISC-IV). Magnetic source activity was assessed using magnetoencephalography calculated for each frequency band using the accumulated source imaging (ASI) technique.

Results

Children with SeLECTS (SWI ≥ 50%) had the lowest cognitive function scores, followed by those with SeLECTS (SWI < 50%) and then healthy controls. There were significant differences in the localization of magnetic source activity between the three groups: in the alpha (8–12 Hz) frequency band, children with SeLECTS (SWI ≥ 50%) showed deactivation of the medial frontal cortex (MFC) region; in the beta (12–30 Hz) frequency band, children with SeLECTS (SWI ≥ 50%) showed deactivation of the posterior cingulate cortex (PCC) segment; and in the gamma (30–80 Hz) frequency band, children in the healthy group showed activation of the PCC region.

Conclusion

This study revealed significant decreases in cognitive function in children with SeLECTS (SWI ≥ 50%) compared to children with SeLECTS (SWI < 50%) and healthy children, as well as significant differences in magnetic source activity between the three groups. The findings suggest that deactivation of magnetic source activity in the PCC and MFC regions is the main cause of cognitive function decline in SeLECTS patients with some frequency dependence.

A Review of AI Cloud and Edge Sensors, Methods, and Applications for the Recognition of Emotional, Affective and Physiological States

Affective, emotional, and physiological states (AFFECT) detection and recognition by capturing human signals is a fast-growing area, which has been applied across numerous domains. The research aim is to review publications on how techniques that use brain and biometric sensors can be used for AFFECT recognition, consolidate the findings, provide a rationale for the current methods, compare the effectiveness of existing methods, and quantify how likely they are to address the issues/challenges in the field. In efforts to achieve the key goals of Society 5.0, Industry 5.0, and human-centered design better, the recognition of emotional, affective, and physiological states is progressively becoming an important matter and offers tremendous growth of knowledge and progress in these and other related fields. In this research, a review of AFFECT recognition brain and biometric sensors, methods, and applications was performed, based on Plutchik's wheel of emotions. Due to the immense variety of existing sensors and sensing systems, this study aimed to provide an analysis of the available sensors that can be used to define human AFFECT, and to classify them based on the type of sensing area and their efficiency in real implementations. Based on statistical and multiple criteria analysis across 169 nations, our outcomes introduce a connection between a nation's success, its number of Web of Science articles published, and its frequency of citation on AFFECT recognition. The principal conclusions present how this research contributes to the big picture in the field under analysis and explore forthcoming study trends.

Neuroimaging of psychiatric disorders

Psychiatry remains the only medical specialty where diagnoses are still based on clinical syndromes rather than measurable biological abnormalities. As imaging technology and analytical methods evolve, it is becoming clear that subtle but measurable radiological characteristics exist and can be used to experimentally classify psychiatric disorders, predict response to treatment and, hopefully, develop new, more effective therapies. This review highlights advances in neuroimaging modalities that are now allowing assessment of brain structure, connectivity and neural network function, describes technical aspects of the most promising methods, and summarizes observations made in some frequent psychiatric disorders.

A night of sleep deprivation alters brain connectivity and affects specific executive functions

Sleep is a fundamental physiological process necessary for efficient cognitive functioning especially in relation to memory consolidation and executive functions, such as attentional and switching abilities. The lack of sleep strongly alters the connectivity of some resting-state networks, such as default mode network and attentional network. In this study, by means of magnetoencephalography (MEG) and specific cognitive tasks, we investigated how brain topology and cognitive functioning are affected by 24 h of sleep deprivation (SD). Thirty-two young men underwent resting-state MEG recording and evaluated in letter cancellation task (LCT) and task switching (TS) before and after SD. Results showed a worsening in the accuracy and speed of execution in the LCT and a reduction of reaction times in the TS, evidencing thus a worsening of attentional but not of switching abilities. Moreover, we observed that 24 h of SD induced large-scale rearrangements in the functional network. These findings evidence that 24 h of SD is able to alter brain connectivity and selectively affects cognitive domains which are under the control of different brain networks.

Where Are We with Deep Brain Stimulation? A Review of Scientific Publications and Ongoing Research

BACKGROUND

Deep brain stimulation (DBS) is a neuromodulatory technique that delivers adjustable electrical stimuli to brain targets to relieve symptoms associated with dysregulated neural circuitry. Over the last several decades, DBS has been applied to a number of conditions, including motor, pain, mood, and cognitive disorders. An assessment of the body of work in this field is warranted to determine where we have been, define the current state of the field, and chart a path toward the future.

OBJECTIVE

The aim of the study was to assess the state of DBS-related research by analyzing the DBS literature as well as active studies sponsored by the National Institutes of Health (NIH) or German Research Foundation (Deutsche Forschungsgemeinschaft [DFG]).

METHODS

Peer-reviewed DBS publications were extracted from PubMed. Active NIH-funded DBS projects were extracted from the RePORT database and active DFG projects from the German Research Foundation database. Records were analyzed using custom-developed algorithms to generate a detailed overview of past and present DBS-related research. Specifically, records were categorized by publication year, journal, language, country of origin, contributing authors, disorder, brain target, study design, and topic. Expected project duration and costs were also provided for active studies.

RESULTS

In total, 8,974 publications, 172 active NIH-funded projects, and 34 active DFG projects were identified. Records spanned 52 different disorders across 31 distinct brain targets and showed a recent shift toward studies examining conditions other than movement disorders. Most published works involved human research (80.6% of published studies), of which 10.2% were identified as clinical trials. Increasingly, studies focused on imaging or electrophysiological changes associated with DBS (69.8% NIH-active and 70.6% DFG-active vs. 25.8% published) or developing new stimulation techniques and adaptive technologies (37.8% NIH-active and 17.6% DFG-active vs. 6.5% published).

CONCLUSIONS

This overview of past and present DBS-related studies provides insight into the status of DBS research and what we can anticipate in the future concerning new indications, improved/novel target selection and stimulation paradigms, closed-loop technology, and a better understanding of the mechanisms of action of DBS.

Deep brain stimulation: is it time to change gears by closing the loop?

Objective.Adaptive deep brain stimulation (aDBS) is a form of invasive stimulation that was conceived to overcome the technical limitations of traditional DBS, which delivers continuous stimulation of the target structure without considering patients' symptoms or status in real-time. Instead, aDBS delivers on-demand, contingency-based stimulation. So far, aDBS has been tested in several neurological conditions, and will be soon extensively studied to translate it into clinical practice. However, an exhaustive description of technical aspects is still missing.Approach.in this topical review, we summarize the knowledge about the current (and future) aDBS approach and control algorithms to deliver the stimulation, as reference for a deeper undestending of aDBS model.Main results.We discuss the conceptual and functional model of aDBS, which is based on the sensing module (that assesses the feedback variable), the control module (which interpretes the variable and elaborates the new stimulation parameters), and the stimulation module (that controls the delivery of stimulation), considering both the historical perspective and the state-of-the-art of available biomarkers.Significance.aDBS modulates neuronal circuits based on clinically relevant biofeedback signals in real-time. First developed in the mid-2000s, many groups have worked on improving closed-loop DBS technology. The field is now at a point in conducting large-scale randomized clinical trials to translate aDBS into clinical practice. As we move towards implanting brain-computer interfaces in patients, it will be important to understand the technical aspects of aDBS.

Impact of Antiepileptic Drugs on Cognition and Neuromagnetic Activity in Childhood Epilepsy With Centrotemporal Spikes: A Magnetoencephalography Study

Objective: Childhood epilepsy with centrotemporal spikes (CECTS), the most common childhood epilepsy, still lacks longitudinal imaging studies involving antiepileptic drugs (AEDs). In order to examine the effect of AEDs on cognition and brain activity. We investigated the neuromagnetic activities and cognitive profile in children with CECTS before and after 1 year of treatment.

Methods: Fifteen children with CECTS aged 6–12 years underwent high-sampling magnetoencephalography (MEG) recordings before treatment and at 1 year after treatment, and 12 completed the cognitive assessment (The Wechsler Intelligence Scale for Children). Next, magnetic source location and functional connectivity (FC) were investigated in order to characterize interictal neuromagnetic activity in the seven frequency sub-bands, including: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), beta (12–30 Hz), gamma (30–80 Hz), ripple (80–250 Hz), and fast ripple (250–500 Hz).

Results: After 1 year of treatment, children with CECTS had increased scores on full-scale intelligence quotient, verbal comprehension index (VCI) and perceptual reasoning index (PRI). Alterations of neural activity occurred in specific frequency bands. Source location, in the 30–80 Hz frequency band, was significantly increased in the posterior cingulate cortex (PCC) after treatment. Moreover, FC analysis demonstrated that after treatment, the connectivity between the PCC and the medial frontal cortex (MFC) was enhanced in the 8–12 Hz frequency band. Additionally, the whole-brain network distribution was more dispersed in the 80–250 Hz frequency band.

Conclusion: Intrinsic neural activity has frequency-dependent characteristic. AEDs have impact on regional activity and FC of the default mode network (DMN). Normalization of aberrant DMN in children with CECTS after treatment is likely the reason for improvement of cognitive function.

Deep Brain Stimulation Does Not Modulate Auditory-Motor Integration of Speech in Parkinson's Disease

Deep brain stimulation (DBS) has significant effects on motor symptoms in Parkinson's disease (PD), but existing studies on the effect of DBS on speech are rather inconclusive. It is assumed that deficits in auditory-motor integration strongly contribute to Parkinsonian speech pathology. The aim of the present study was to assess whether subthalamic DBS can modulate these deficits. Twenty PD patients (15 male, 5 female; 62.4 ± 6.7 years) with subthalamic DBS were exposed to pitch-shifted acoustic feedback during vowel vocalization and subsequent listening. Voice and brain activity were measured ON and OFF stimulation using magnetoencephalography (MEG). Vocal responses and auditory evoked responses time locked to the onset of pitch-shifted feedback were examined. A positive correlation between vocal response magnitude and pitch variability was observed for both, stimulation ON and OFF (ON: r = 0.722, p < 0.001, OFF: r = 0.746, p < 0.001). However, no differences of vocal responses to pitch-shifted feedback between the stimulation conditions were found [t₍₁₉₎ = −0.245, p = 0.809, d = −0.055]. P200m amplitudes of event related fields (ERF) of left and right auditory cortex (AC) and superior temporal gyrus (STG) were significantly larger during listening [left AC P200m: F_{(1, 19)} = 10.241, p = 0.005, f = 0.734; right STG P200m: F_{(1, 19)} = 8.393, p = 0.009, f = 0.664]. Subthalamic DBS appears to have no substantial effect on vocal compensations, although it has been suggested that auditory-motor integration deficits contribute to higher vocal response magnitudes in pitch perturbation experiments with PD patients. Thus, DBS seems to be limited in modulating auditory-motor integration of speech in PD.

The comparative performance of DBS artefact rejection methods for MEG recordings

Deep brain stimulation (DBS) can be a very efficient treatment option for movement disorders and psychiatric diseases. To better understand DBS mechanisms, brain activity can be recorded using magnetoencephalography (MEG) with the stimulator turned on. However, DBS produces large artefacts compromising MEG data quality due to both the applied current and the movement of wires connecting the stimulator with the electrode. To filter out these artefacts, several methods to suppress the DBS artefact have been proposed in the literature. A comparative study evaluating each method’s effectiveness, however, is missing so far.

In this study, we evaluate the performance of four artefact rejection methods on MEG data from phantom recordings with DBS acquired with an Elekta Neuromag and a CTF system: (i) Hampel-filter, (ii) spectral signal space projection (S3P), (iii) independent component analysis with mutual information (ICA-MI), and (iv) temporal signal space separation (tSSS). In the sensor space, the largest increase in signal-to-noise (SNR) ratio was achieved by ICA-MI, while the best correspondence in terms of source activations was obtained by tSSS. LCMV beamforming alone was not sufficient to suppress the DBS-induced artefacts.

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Phantom MEG measurement with Elekta Neuromag and CTF MEG system with DBS.

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Systematic comparison of cleaning algorithms to remove DBS artefact from MEG data.

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Sensor level ICA-MI yielded the best results.

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Source level: tSSS provided the best correspondence to recording without DBS.

Motor effects of deep brain stimulation correlate with increased functional connectivity in Parkinson's disease: An MEG study

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established symptomatic treatment in Parkinson's disease, yet its mechanism of action is not fully understood. Locally in the STN, stimulation lowers beta band power, in parallel with symptom relief. Therefore, beta band oscillations are sometimes referred to as "anti-kinetic". However, in recent studies functional interactions have been observed beyond the STN, which we hypothesized to reflect clinical effects of DBS. Resting-state, whole-brain magnetoencephalography (MEG) recordings and assessments on motor function were obtained in 18 Parkinson's disease patients with bilateral STN-DBS, on and off stimulation. For each brain region, we estimated source-space spectral power and functional connectivity with the rest of the brain. Stimulation led to an increase in average peak frequency and a suppression of absolute band power (delta to low-beta band) in the sensorimotor cortices. Significant changes (decreases and increases) in low-beta band functional connectivity were observed upon stimulation. Improvement in bradykinesia/rigidity was significantly related to increases in alpha2 and low-beta band functional connectivity (of sensorimotor regions, the cortex as a whole, and subcortical regions). By contrast, tremor improvement did not correlate with changes in functional connectivity. Our results highlight the distributed effects of DBS on the resting-state brain and suggest that DBS-related improvements in rigidity and bradykinesia, but not tremor, may be mediated by an increase in alpha2 and low-beta functional connectivity. Beyond the local effects of DBS in and around the STN, functional connectivity changes in these frequency bands might therefore be considered as "pro-kinetic".

Evaluation of methodologies for computing the deep brain stimulation volume of tissue activated

Objective.

Computational models are a popular tool for predicting the effects of deep brain stimulation (DBS) on neural tissue. One commonly used model, the volume of tissue activated (VTA), is computed using multiple methodologies. We quantified differences in the VTAs generated by five methodologies: the traditional axon model method, the electric field norm, and three activating function based approaches—the activating function at each grid point in the tangential direction (AF-Tan) or in the maximally activating direction (AF-3D), and the maximum activating function along the entire length of a tangential fiber (AF-Max).

Approach.

We computed the VTA using each method across multiple stimulation settings. The resulting volumes were compared for similarity, and the methodologies were analyzed for their differences in behavior.

Main results.

Activation threshold values for both the electric field norm and the activating function varied with regards to electrode configuration, pulse width, and frequency. All methods produced highly similar volumes for monopolar stimulation. For bipolar electrode configurations, only the maximum activating function along the tangential axon method, AF-Max, produced similar volumes to those produced by the axon model method. Further analysis revealed that both of these methods are biased by their exclusive use of tangential fiber orientations. In contrast, the activating function in the maximally activating direction method, AF-3D, produces a VTA that is free of axon orientation and projection bias.

Significance.

Simulating tangentially oriented axons, the standard approach of computing the VTA, is too computationally expensive for widespread implementation and yields results biased by the assumption of tangential fiber orientation. In this work, we show that a computationally efficient method based on the activating function, AF-Max, reliably reproduces the VTAs generated by direct axon modeling. Further, we propose another method, AF-3D as a potentially superior model for representing generic neural tissue activation.

Quantitatively validating the efficacy of artifact suppression techniques to study the cortical consequences of deep brain stimulation with magnetoencephalography

Deep brain stimulation (DBS) is an established and effective treatment for several movement disorders and is being developed to treat a host of neuropsychiatric disorders including epilepsy, chronic pain, obsessive compulsive disorder, and depression. However, the neural mechanisms through which DBS produces therapeutic benefits, and in some cases unwanted side effects, in these disorders are only partially understood. Non-invasive neuroimaging techniques that can assess the neural effects of active stimulation are important for advancing our understanding of the neural basis of DBS therapy. Magnetoencephalography (MEG) is a safe, passive imaging modality with relatively high spatiotemporal resolution, which makes it a potentially powerful method for examining the cortical network effects of DBS. However, the degree to which magnetic artifacts produced by stimulation and the associated hardware can be suppressed from MEG data, and the comparability between signals measured during DBS-on and DBS-off conditions, have not been fully quantified. The present study used machine learning methods in conjunction with a visual perception task, which should be relatively unaffected by DBS, to quantify how well neural data can be salvaged from artifact contamination introduced by DBS and how comparable DBS-on and DBS-off data are after artifact removal. Machine learning also allowed us to determine whether the spatiotemporal pattern of neural activity recorded during stimulation are comparable to those recorded when stimulation is off. The spatiotemporal patterns of visually evoked neural fields could be accurately classified in all 8 patients with DBS implants during both DBS-on and DBS-off conditions and performed comparably across those two conditions. Further, the classification accuracy for classifiers trained on the spatiotemporal patterns evoked during DBS-on trials and applied to DBS-off trials, and vice versa, were similar to that of the classifiers trained and tested on either trial type, demonstrating the comparability of these patterns across conditions. Together, these results demonstrate the ability of MEG preprocessing techniques, like temporal signal space separation, to salvage neural data from recordings contaminated with DBS artifacts and validate MEG as a powerful tool to study the cortical consequences of DBS.

Cortico-subthalamic Coherence in a Patient With Dystonia Induced by Chorea-Acanthocytosis: A Case Report

The subthalamic nucleus (STN) is a common target for deep brain stimulation (DBS) treatment in Parkinson's disease (PD) but much less frequently targeted for other disorders. Here we report the results of simultaneous local field potential (LFP) recordings and magnetoencephalography (MEG) in a single patient who was implanted bilaterally in the STN for the treatment of dystonia induced by chorea-acanthocytosis. Consistent with the previous results in PD, the dystonia patient showed significant subthalamo-cortical coherence in the high beta band (28-35 Hz) on both sides localized to the mesial sensorimotor areas. In addition, on the right side, significant coherence was found in the theta-alpha band (4-12 Hz) that localized to the medial prefrontal cortex with the peak in the anterior cingulate gyrus. Comparison of STN power spectra with a previously reported PD cohort showed increased power in the theta and alpha bands and decreased power in the low beta band in dystonia which is consistent with most of the previous studies. The present report extends the range of disorders for which cortico-subthalamic oscillatory connectivity has been characterized. Our results strengthen the evidence that at least some of the subthalamo-cortical oscillatory coherent networks are a feature of the healthy brain, although we do not rule out that coherence magnitude could be affected by disease.

A systematic review of MEG-based studies in Parkinson's disease: The motor system and beyond

Parkinson's disease (PD) is accompanied by functional changes throughout the brain, including changes in the electromagnetic activity recorded with magnetoencephalography (MEG). An integrated overview of these changes, its relationship with clinical symptoms, and the influence of treatment is currently missing. Therefore, we systematically reviewed the MEG studies that have examined oscillatory activity and functional connectivity in the PD‐affected brain. The available articles could be separated into motor network‐focused and whole‐brain focused studies. Motor network studies revealed PD‐related changes in beta band (13–30 Hz) neurophysiological activity within and between several of its components, although it remains elusive to what extent these changes underlie clinical motor symptoms. In whole‐brain studies PD‐related oscillatory slowing and decrease in functional connectivity correlated with cognitive decline and less strongly with other markers of disease progression. Both approaches offer a different perspective on PD‐specific disease mechanisms and could therefore complement each other. Combining the merits of both approaches will improve the setup and interpretation of future studies, which is essential for a better understanding of the disease process itself and the pathophysiological mechanisms underlying specific PD symptoms, as well as for the potential to use MEG in clinical care.

Distinct cortical responses evoked by electrical stimulation of the thalamic ventral intermediate nucleus and of the subthalamic nucleus

Objective

To investigate the spatial and temporal pattern of cortical responses evoked by deep brain stimulation (DBS) of the subthalamic nucleus (STN) and ventral intermediate nucleus of the thalamus (VIM).

Methods

We investigated 7 patients suffering from Essential tremor (ET) and 7 patients with Parkinson's Disease (PD) following the implantation of DBS electrodes (VIM for ET patients, STN for PD patients). Magnetoencephalography (MEG) was used to record cortical responses evoked by electric stimuli that were applied via the DBS electrode in trains of 5 Hz. Dipole fitting was applied to reconstruct the origin of evoked responses.

Results

Both VIM and STN DBS led to short latency cortical responses at about 1 ms. The pattern of medium and long latency cortical responses following VIM DBS consisted of peaks at 13, 40, 77, and 116 ms. The associated equivalent dipoles were localized within the central sulcus, 3 patients showed an additional response in the cerebellum at 56 ms. STN DBS evoked cortical responses peaking at 4 ms, 11 ms, and 27 ms, respectively. While most dipoles were localized in the pre- or postcentral gyrus, the distribution was less homogenous compared to VIM stimulation and partially included prefrontal brain areas.

Conclusion

MEG enables localization of cortical responses evoked by DBS of the VIM and the STN, especially in the sensorimotor cortex. Short latency responses of 1 ms suggest cortical modulation which bypasses synaptic transmission, i.e. antidromic activation of corticofugal fiber pathways.

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Cortical responses evoked by VIM or STN DBS can be precisely described using MEG.

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Both STN and VIM DBS primarily evoke cortical responses within the sensorimotor region.

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Short latency responses of 1 ms both observed in VIM and STN DBS suggest antidromic activation of corticofugal fibers.

Spontaneous sensorimotor cortical activity is suppressed by deep brain stimulation in patients with advanced Parkinson's disease

Advanced Parkinson's disease (PD) is characterized by an excessive oscillatory beta band activity in the subthalamic nucleus (STN). Deep brain stimulation (DBS) of STN alleviates motor symptoms in PD and suppresses the STN beta band activity. The effect of DBS on cortical sensorimotor activity is more ambiguous; both increases and decreases of beta band activity have been reported. Non-invasive studies with simultaneous DBS are problematic due to DBS-induced artifacts. We recorded magnetoencephalography (MEG) from 16 advanced PD patients with and without STN DBS during rest and wrist extension. The strong magnetic artifacts related to stimulation were removed by temporal signal space separation. MEG oscillatory activity at 5-25 Hz was suppressed during DBS in a widespread frontoparietal region, including the sensorimotor cortex identified by the cortico-muscular coherence. The strength of suppression did not correlate with clinical improvement. Our results indicate that alpha and beta band oscillations are suppressed at the frontoparietal cortex by STN DBS in PD.