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Locked to the match: subthalamic engagement in sport match viewing

Falciglia, S.; Caffi, L.; Luiso, F.; Palmisano, C.; Mazzoni, A.; Isaias, I. U.

2026-05-22 neurology
10.64898/2026.05.20.26353675 medRxiv
Show abstract

Adaptive deep brain stimulation (aDBS) of the subthalamic nucleus (STN) ameliorates motor symptoms in advanced Parkinson's disease (PD) by modulating stimulation in real time using neural signals linked to motor symptoms. Whether these signals also reflect ongoing behavior in naturalistic settings remains unknown. We recorded bilateral STN local field potentials from eight PD patients undergoing aDBS during live-streamed sports viewing and show that low-frequency dynamics encode behavioral engagement across multiple timescales. Engaged viewing increased activity in the stimulation-targeted frequency band relative to control conditions. At a finer timescale, moment-to-moment engagement modulated rapid fluctuations in left STN activity with amplitude maxima and minima time-locked to salient in-match events. These findings reveal that STN activity dynamically reflects real-world behavioral states and establish a foundation for behaviorally informed neuromodulation strategies.

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