At-Home Intracranial Recordings Reveal Circadian Rhythms in Patients with PD

Globus pallidus internus (GPi) activity in patients with Parkinson’s disease (PD) was strongly modulated by circadian rhythms, according to a study published in Nature Communications.

“Recent research has increasingly focused on the development of adaptive deep brain stimulation (aDBS) algorithms, which use neural signals as feedback control to increase or decrease stimulation based on the presence of pathological activity. However, natural fluctuations of biomarkers due to sleep/wake cycles … may add complexity to the implementation of aDBS,” wrote corresponding author Coralie de Hemptinne, PhD, of the University of Florida, Gainesville, Florida, and coauthors in the study introduction.

Researchers investigated circadian patterns of neural activity in the GPi in patients with PD implanted with a neurostimulator. GPi activity was chronically recorded in home environments under naturalistic conditions, including typical therapeutic medications and stimulation. The study included 130 recordings from 93 patients.

The study showed that 82.4% of patients significantly changed GPi activity between daytime and nighttime hours. GPi activity at night decreased in 56.2% of the recordings and increased in 26.2%.

GPi activity in higher frequency bands, and in patients taking extended-release levodopa medication, was more likely to decrease at night, the study found.

“The use of extended-release levodopa could suppress beta power at nighttime similar to the daytime, thus masking the re-emergence of pathological beta power at night as seen in subjects who were not taking extended-release levodopa,” researchers wrote. “This is supported by the baseline recording comparison, showing that subjects with increased power at nighttime had significantly higher power in the awake off-medication off-stimulation state.”

Consequently, aDBS algorithms may need to be adapted for nighttime therapy in the event of  medication changes, the study advised.

“Thus, we caution that while aDBS can improve the responsiveness of neuromodulation therapy in PD, the algorithms will need to be tailored to each subject’s neural signature for optimal therapeutic benefit,” researchers wrote, “and circadian patterns are an important consideration.”

Reference

Cagle JN, de Araujo T, Johnson KA, et al. Chronic intracranial recordings in the globus pallidus reveal circadian rhythms in Parkinson's disease. Nat Commun. 2024;15(1):4602. doi:10.1038/s41467-024-48732-0