Stimulation-Evoked Resonant Neural Activity in the Subthalamic Nucleus Is Modulated by Sleep

Deep brain stimulation is a treatment for advanced Parkinson's disease and currently tuned to target motor symptoms during daytime. Parkinson's disease is associated with multiple nocturnal symptoms such as akinesia, insomnia, and sleep fragmentation, which may require adjustments of stimulation during sleep for best treatment outcome. There is a need for a robust biomarker to guide stimulation titration across sleep stages. This study aimed to investigate whether evoked resonant neural activity (ERNA) is modulated by sleep. We recorded local field potentials from the subthalamic nucleus of four Parkinson's patients with externalized electrodes while applying single stimulation pulses to investigate the effect of sleep on ERNA. We found that ERNA features change with wakefulness and sleep stages and are correlated with canonical frequency bands and heart rate. Given that ERNA modulates with sleep, it could be used as a robust marker for automatic stimulation titration during sleep. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.