Abstract Details

Title Excessive Pallidal Beta-band Activity and Functional Connectivity: A Novel Intracranial Biomarker of Status Dystonicus

Topic Movement Disorders

Presentation(s) P10 - Poster Session 10 (5:00 PM-6:00 PM)

Poster/Presentation
Number 5-001

Objective

Characterize novel neural correlates of status dystonicus (SD) and assess their relation to clinical severity.

Background

SD is an emergency with severe episodes of dystonia, necessitating urgent hospital admission. Deep brain stimulation (DBS) of the globus pallidus interna (GPi) is a treatment for refractory SD. Intracranial neural correlates to SD-states and corresponding clinical severity are unknown.

Design/Methods

Methods:

Nine patients with SD (Hospital for Sick Children, Canada) were implanted with sensing-capable Medtronic Percept™GPi DBS (age: 7.8±3.6). Local Field Potentials (LFPs) were recorded at multiple time points during SD and after recovery in non-SD states longitudinally (6-36 months; range: 11-1155 days; average: 319±358 days) and Power Spectral Densities (PSDs) calculated (Welch-method). Analysis of PSD periodic and aperiodic components was performed using fitting-oscillations/one-over-f methods. Band-limited power (Theta: 3-7Hz; Alpha: 7-12.5Hz, Beta: 12.5-30Hz, Gamma: 30-60Hz) was calculated. Intra-pallidal functional connectivity in SD and non-SD was computed using magnitude squared coherence (MSC) between outer (contact 3-referenced-to-2) and inner (1-to-0) GPi. Mixed effects models (MEMs) assessed relations between LFP metrics and clinical scales, including Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Pediatric Quality of Life Score (PedsQL).

Results

Results:

Across all patient recordings at optimal contact points, the peak power of the periodic component of the LFP in the beta-band (p=0.01) and band-limited beta-band power (p<0.001) increased in SD compared to non-SD. GPi beta-band MSC (p<0.001) increased in SD (0.24±0.10) from non-SD (0.16±0.08). MEMs controlling for random effects of patient and time determined significant correlation (R2=0.80) between decreased PedsQL and increased beta power (p=0.004; intercept p=0.007). Results were beta-band specific with no significant associations with theta (p=0.793) or alpha-band power (p=0.877). Similar results were seen for PedsQL motor-subscores but not BFMDRS.

Conclusions

Excessive pallidal beta-band activity and functional connectivity are newly described biomarkers of SD, correlating with clinical severity.

Authors/Disclosures
Arjun Balachandar, MD PRESENTER	Dr. Balachandar has nothing to disclose.
Lindsey Vogt, MD (Work)	Dr. Vogt has nothing to disclose.
Karim Mithani, MD, MEng	Dr. Mithani has received research support from Canadian Institutes of Health Research. Dr. Mithani has received research support from Hospital for Sick Children Clinician-Scientist Training Program. Dr. Mithani has received research support from IMPaCT. Dr. Mithani has received research support from Hold 'Em for Life Oncology Fellowship. Dr. Mithani has received personal compensation in the range of $50,000-$99,999 for serving as a Resident Physician with Ontario Ministry of Health.
Sebastian C. Coleman, PhD	Dr. Coleman has nothing to disclose.
Mark Ebden, DPhil	Dr. Ebden has nothing to disclose.
Andrea LeBlanc-Millar, NP	Mrs. LeBlanc-Millar has nothing to disclose.
Sara Breitbart, NP	Ms. Breitbart has nothing to disclose.
Alfonso Fasano, MD, PhD, FAAN (Toronto Western Hospital - U of Toronto)	Dr. Fasano has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbott. Dr. Fasano has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ipsen. Dr. Fasano has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Fasano has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Scientific. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbott. Dr. Fasano has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceregate. Dr. Fasano has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Inbrain Neuroelectronics. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Syneos Health. Dr. Fasano has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Annovis. Dr. Fasano has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for CADTH. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for International Parkinson and Movement Disorders Society. The institution of Dr. Fasano has received research support from Boston Scientific. The institution of Dr. Fasano has received research support from Medtronic. The institution of Dr. Fasano has received research support from Abbvie. The institution of Dr. Fasano has received research support from Canadian Institutes of Health Research (CIHR). The institution of Dr. Fasano has received research support from Michael J Fox Foundation. The institution of Dr. Fasano has received research support from Bluerock Therapeutics. Dr. Fasano has received publishing royalties from a publication relating to health care. Dr. Fasano has a non-compensated relationship as a Medical Advisory Committee with CenteR for Advancing Neurological Innovation to Application (CRANIA) that is relevant to AAN interests or activities. Dr. Fasano has a non-compensated relationship as a Medical Advisory Committee with HopeNET that is relevant to AAN interests or activities. Dr. Fasano has a non-compensated relationship as a Medical Advisory Committee with International Essential Tremor Foundation that is relevant to AAN interests or activities. Dr. Fasano has a non-compensated relationship as a Member with Tremor Research Group that is relevant to AAN interests or activities. Dr. Fasano has a non-compensated relationship as a Co-Chair with Tremor Study Group of the IPMDS that is relevant to AAN interests or activities. Dr. Fasano has a non-compensated relationship as a Vice-Chair with NPH Study Group of the IPMDS that is relevant to AAN interests or activities. Dr. Fasano has a non-compensated relationship as a Vice-Chair with Industry Committee of the IPMDS that is relevant to AAN interests or activities.
Carolina Gorodetsky, MD (Hospital for Sick Children)	Dr. Gorodetsky has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic Inc . Dr. Gorodetsky has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic Inc . Dr. Gorodetsky has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic Inc .
George Ibrahim (The Hospital for Sick Children)	George Ibrahim has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. George Ibrahim has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Synergia. George Ibrahim has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Livanova. George Ibrahim has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Synergia.

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