Movement execution defines a distinct neural state in dyskinesia and enhances decoding

Parkinson patients suffer from levodopa-induced dyskinesia, which occur adversely to chronic dopaminergic treatment. These abnormal involuntary movements can only partly be actively suppressed and affect quality of life. A lowered motor inhibition during hyperdopaminergic states, associated with structural and plasticity changes in the cortico-basal-ganglia motor network, is hypothesized to enable dyskinesia. Oscillatory cortico-subthalamic patterns associated with dyskinesia are proposed as adaptive neuromodulation biomarkers, but their dependence on behavioral states such as dyskinetic movement presence or suppression remains unknown. We studied cortico-subthalamic oscillations in 22 Parkinsons patients during dyskinesia-evoking protocols. We clinically differentiated between non-dyskinetic and dyskinetic periods, and defined movement presence with kinematics, leading to four behavioral states containing rest, voluntary movements, movement suppression during dyskinesia, and dyskinetic movements. Elevated subthalamic theta-activity and attenuated beta-activity was found during both dyskinetic movement suppression and execution, while cortico-subthalamic gamma-activity only increased during dyskinetic movement execution. Subthalamic spectral changes significantly predicted dyskinesia presence, and movement presence significantly affected the predictive performance. A movement-aware classifier enhanced dyskinesia detection based on movement-depending biomarkers containing cortical oscillations and gamma-bands. We propose movement execution during dyskinesia to be a distinct behavioral and neural microstate within a dopamine-depending dyskinetic macrostate, that can enhance dyskinesia classification for adaptive neuromodulation.