Beta-driven closed-loop deep brain stimulation can compromise human motor behavior in Parkinson’s Disease

Closed-loop or adaptive deep brain stimulation (DBS) for Parkinsons Disease (PD) has shown comparable clinical improvements to continuous stimulation, yet with less stimulation times and side effects. In this form of control, stimulation is driven by pathological beta oscillations recorded from the subthalamic nucleus, which have been shown to correlate with PD motor symptoms. An important consideration is that beta activity is itself modulated during volitional movements, yet it is unknown the impact that these volitional modulations may have on the efficacy of closed-loop systems. Here, three PD patients performed a functional reaching task during closed-loop stimulation while we measured their motor behavior. Our results show that closed-loop stimulation can alter motor performance at distinct movement intervals. Of particular relevance, closed-loop DBS compromised behavior during the returning period by increasing the amount of submovements executed, and in turn delayed movement termination. Following these findings, we hypothesize that the use of machine learning decoding different movement intervals to fully switch off the stimulator may be beneficial, and present here an exemplary approach decoding the initiation of the movement returning interval above chance level. These findings highlight the importance of evaluating these systems during functional tasks, and the need of extracting more robust biomarkers encoding ongoing symptoms or tasks execution intervals.