Paradoxical Modulation of STN β-Band Activity with Medication Compared to Deep Brain Stimulation

Background: Excessive subthalamic nucleus (STN) beta-band (13-35 Hz) synchronized oscillations has garnered interest as a biomarker for characterizing disease state and developing adaptive stimulation systems for Parkinson's disease (PD).Objectives: To report on a patient with abnormal treatment-responsive modulation in the beta-band.Methods: We examined STN local field potentials from an externalized deep brain stimulation (DBS) lead while assessing PD motor signs in four conditions (OFF, MEDS, DBS, and MEDS+DBS).Results: The patient presented here exhibited a paradoxical increase in beta power following administration of levodopa and pramipexole (MEDS), but an attenuation in beta power during DBS and MEDS+DBS despite clinical improvement of 50% or greater under all three therapeutic conditions.Conclusions: This case highlights the need for further study on the role of beta oscillations in the pathophysiology of PD and the importance of personalized approaches to the development of beta or other biomarker-based DBS closed loop algorithms. (c) 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.