Frequency-dependent modulation of evoked potentials during GPi-DBS in pediatric dystonia

Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an established treatment for dystonia, yet the neurophysiological mechanisms underlying frequency-dependent effects remain poorly understood. In this study, we investigate how different GPi-DBS frequencies modulate evoked potential (EP) characteristics within the basal ganglia-thalamo-cortical network in pediatric dystonia patients. We evaluated how increasing stimulation frequency alters EP morphology, focusing on peak-to-peak amplitude (PPa), peak-to-peak duration (PPd), and time to peak (TP). This analysis was motivated by clinical observations that higher DBS frequencies often produce distinct therapeutic effects, suggesting underlying differences in how neural circuits respond to varying stimulation rates. We analyzed intracranial electrophysiological recordings from 13 pediatric and young adult dystonia patients undergoing staged DBS implantation. EPs were recorded from the GPi and subthalamic nucleus (STN) of basal ganglia, and ventral oralis (VO) nucleus of the thalamus during unilateral GPi stimulation at 55, 85, 185, and 250 Hz. EP detection and characterization were performed using an automated algorithm, and group-level analyses were conducted using linear mixed effects models to assess frequency-dependent changes across regions. Increasing stimulation frequency significantly decreased PPa and increased PPd and TP, with a clear threshold effect: 55 Hz and 85 Hz produced similar responses, while 185 Hz and 250 Hz elicited significantly greater changes. These frequency-dependent effects were most pronounced in GPi recordings, followed by STN and VO, suggesting that local circuit dynamics are more sensitive to frequency modulation. Our findings highlight the distinct neurophysiological effects of DBS frequency on EP characteristics, emphasizing the need for personalized DBS programming. The pronounced frequency-dependent modulation observed in GPi suggests that optimal stimulation parameters should be tailored to the target region rather than applying uniform settings across patients. Future studies should investigate the clinical relevance of these EP dynamics and explore their potential as biomarkers for DBS optimization in dystonia.