Instantaneous-Frequency EEG Microstate Dynamics Stratify Motor Subtypes in Parkinson's Disease

Parkinson's disease (PD) is clinically heterogeneous, yet objective electrophysiological markers of its postural-instability/gait-difficulty (PIGD) and tremor-dominant (TD) motor subtypes are lacking. We tested whether the temporal dynamics of instantaneous-frequency (IF) microstates in resting-state electroencephalography (EEG) distinguish these subtypes from each other and from healthy controls (HC). In a publicly available cohort (OpenNeuro ds007526) comprising 28 HC and 97 PD patients classified as PIGD (n=50) or TD (n=47), the spatial distribution of the IF was reduced by principal component analysis and modeled with a Gaussian hidden Markov model, yielding three recurrent microstates. Per-participant mean dwell time, occupancy, and state-transition probabilities were compared across the three groups and, within PD, correlated with clinical scores. We found that the dynamics of one microstate varied systematically across groups: its dwell time, occupancy, and self-transition probability increased monotonically from HC through TD to PIGD, while outgoing transitions decreased, so that the state became an increasingly persistent attractor. For dwell time, all three pairwise contrasts survived correction (HC versus PIGD, Hedges' g=1.06; HC versus TD, g=0.59; PIGD versus TD, g=0.40). None of the dynamic indices was associated with clinical severity, disease duration, or medication dose within PD. IF-microstate dynamics thus stratify the PD motor subtypes along a graded continuum without tracking continuous disease severity. The approach offers a candidate objective EEG marker for motor-subtype stratification, complementing spectral characterizations of PD.