EAN 2026 | Subthalamic deep brain stimulation and sleep in Parkinson’s disease

This research was actually a part of my PhD and in this research we actually considered patients with Parkinson’s disease undergoing deep brain stimulation. And with a double aim. On the first part we actually wanted to investigate the impact on sleep, not only on sleep quality but also on sleep structure by means of video polysomnography of deep brain stimulation to see how sleep architecture was modified by deep brain stimulation. And what we saw is that actually, going along with better sleep quality, this also was consequential to an increase of deep sleep and a small decrease of light sleep, even if circadian patterns didn’t actually didn’t change. On the other end, thanks to the fact that nowadays we have the possibility with new technologies to record what we are stimulating, we considered patients with deep brain stimulation in the subthalamic nucleus and therefore we were able to record the local field potentials in the subthalamic nucleus during the night synchronized with video polysomnography. So not only the EEG during sleep but all the polysomnographic signals. This was important for several reasons. First, it is important to try to find intracranial signatures of sleep because nowadays we have the possibility to adapt the stimulation with these devices depending on the recordings of the local field potentials. And this is done usually during the day if the patient is defined as ‘on’ more active, more on, or more inactive, ‘off’ where the patient may have more motor problems, and this is nowadays done on specific bands, especially the beta band. But we don’t know specifically how this band behaves during sleep and it would be good also to inform these devices what is happening in sleep. For example, by reducing the stimulation during sleep or adapting the stimulation before the patient actually wakes up during arousals and subsequent awakenings during the night.

And another point was delving into the neurophysiological patterns of REM sleep behavior disorder because, by recording it, these patients with Parkinson’s disease also had REM sleep behavior disorder and the hypothesis is that these patients move better during REM sleep behavior disorder episodes. The basal ganglia may not be included in the REM sleep behavior disorder patterns. Some nuclear medicine evidence suggested that these nuclei do not activate during this part of the episode and in this disorder.
We were able to record hence the subthalamic nucleus during REM sleep behavior disorder episodes. And what we actually found, we found a change of the activation pattern of the local field potentials during these episodes, also distinguishing simple motor activation during REM sleep with more complex episodes, suggesting that even if not primary there is actually an activation of the basal ganglia during this type of episode in REM sleep behavior disorder episode. Therefore, I believe with this study we tried to increase the knowledge by giving data to allow, in the future, a real sleep-aware deep brain stimulation and also, on the other side, to delve more into the neurophysiology of these disorders.

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