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(21) Correlation Between DLEPs and Therapeutic Outcomes in Parkinson’s: Awake vs. Asleep Surgery Insights

Friday, June 13, 2025
4:30 PM - 5:10 PM ET
Location: Sky View
Introduction: Deep Brain Stimulation (DBS) is a well-established treatment for Parkinson’s Disease (PD), yet challenges persist in achieving optimal surgical implantation and postoperative programming. Approximately 34% of DBS surgeries are revisions, underscoring the need for improved techniques (Rolston et al., 2016). The DBS local evoked potential (DLEP) offers a promising approach to enhance surgical precision and patient comfort by enabling functional mapping during asleep procedures. This study investigates the ability of DLEP amplitude to predict therapeutic outcomes in PD patients undergoing DBS targeting the globus pallidus internus (GPi) or subthalamic nucleus (STN) during both awake and asleep surgery.

Methods: Local field potentials were recorded from 30 awake patients (16 STN, 14 GPi) and 12 STNs under general anesthesia (GA). DLEPs were evoked using high-frequency (130Hz) and low-frequency (11Hz) stimulation. Post-processing techniques isolated DLEP activity from stimulation artifacts, and DLEP amplitudes are measured as the root mean square (RMS) envelope of average DLEPs from 5 to 20ms after stimulation. Postoperative lead localization was performed using image-guided reconstruction with LeadDBS.

Results: Higher DLEP RMS amplitudes were observed near known sensorimotor surgical targets. In the GPi, DLEPs within 0.5 mm of the dorsal edge (above or below) exhibited significantly higher amplitudes than those evoked 2 mm above the border (p = 0.005). In both the awake and GA STN, DLEP amplitudes at least 0.25 mm above the dorsal border were smaller compared to those within the nucleus (p < 0.05). DLEP amplitudes are significantly lower when evoked ventral to the STN under GA (p = 0.002), but no significant differences were observed ventral to the awake STN or GPi.
Clinically, the contact chosen for chronic stimulation matched one of the two contacts eliciting the highest DLEP amplitudes in 70% of awake STN hemispheres and 60% of GA STN hemispheres. Additionally, contacts with the lowest effect threshold corresponded to those with the highest DLEP amplitudes in 80% of hemispheres, both awake and under GA. High-frequency stimulation demonstrated better spatial consistency between awake and GA states (R²: 0.46, p-value: 8.2e-15) than low-frequency stimulation (R²: 0.19, p-value: 5.3e-5) though amplitude distributions are significantly correlated for both.

Conclusion: Our findings demonstrate a strong correlation between DLEP amplitudes and therapeutic outcomes in PD patients undergoing DBS. DLEPs show promise as a tool for improving surgical targeting and programming, potentially reducing revision rates and enhancing patient outcomes. High-frequency stimulation may offer greater spatial consistency than low-frequency stimulation.