Cortical and STN spectral changes during limb movements in PD patients with and without dystonia
Background: Dystonia is a prevalent yet under-studied motor feature of Parkinson disease (PD). Although considerable efforts have focused on brain oscillations related to the cardinal symptoms of PD, whether dystonia is associated with specific electrophysiological features is unclear. Objectives: To investigate subcortical and cortical field potentials at rest and during contralateral hand and foot movements in PD patients with versus without dystonia. Methods: We examined the prevalence and somatotopy of dystonia in PD patients undergoing deep brain stimulation (DBS) surgery. We recorded intracranial electrophysiology from sensorimotor cortex and directional DBS electrodes in subthalamic nucleus (STN), during both rest and voluntary contralateral limb movements. We used wavelet transforms and linear mixed models to characterize spectral content in patients with and without dystonia (n=25). Results: Dystonia was highly prevalent at enrollment (61%) and most common in the foot (78%). PD patients with dystonia display greater subthalamic theta and alpha power during movement (p < 0.05) but not at rest. Regardless of dystonia status, cortical recordings display prominent beta desynchronization (13-30 Hz) during movement, whereas STN signals show increases in spectral power at lower frequencies (4-20 Hz), with peaks at 6.0 +/- 3.3 and 4.2 +/- 2.9 Hz during hand and foot movements, respectively (p < 0.03). Conclusions: Whereas cortex was characterized by beta desynchronization during hand and foot movements similarly, STN showed limb-specific low frequency activity which was increased in PD patients with dystonia. These findings may help elucidate why PD-related dystonia is most common in the foot and help guide future closed-loop DBS devices.