Onderzoek naar het gebruik van elektrofysiologische opgewekte potentialen bij diepe hersenstimulatie

Deep brain stimulation (DBS) is an established therapy for several neurological and psychiatric disorders, yet its optimization still largely relies on trial and error. Despite advances in imaging and stimulation hardware, robust physiological markers to guide electrode placement and programming are still lacking. Evoked potentials (EPs), measurable time-locked electrical responses to stimulation, represent an emerging approach for objectively assessing network engagement and clinical efficacy. This thesis explores the utility of DBS-evoked potentials across three major indications: Parkinson's disease (PD), obsessive-compulsive disorder (OCD), and treatment-resistant depression (TRD). In PD, we investigated evoked resonant neural activity (ERNA) in the subthalamic nucleus. ERNA scaled with stimulation amplitude, varied systematically across directional contacts, and the derived electrophysiological sweet spot closely mapped onto previously established sites associated with clinical benefit. Comparative analyses across disorders further indicated that the presence of ERNA primarily reflects engagement of the STN-GPe circuitry, whereas its morphology appears to vary with disease-specific pathology. In OCD, we examined intraoperative electroencephalography (EEG) during anterior limb of the internal capsule (ALIC) stimulation. We showed that EP amplitude corresponded with white matter tracts connected to the prefrontal cortex, which have previously been implicated in clinical effectiveness, supporting their use as biomarkers of target engagement. In TRD, high-density EEG recordings during subcallosal cingulate cortex (SCC) stimulation revealed reproducible spatio-temporal patterns that differentiated therapeutic from non-therapeutic stimulation contacts, reflecting engagement of distinct white matter pathways implicated in mood regulation. Together, these studies demonstrate that DBS-evoked potentials convey physiologically and clinically relevant information across disorders and targets. By linking evoked responses to anatomical lead placement derived from imaging, and in other targets by relating them to structural connectivity and clinical response, this work advances EPs as biomarkers for personalized DBS, with the potential to improve targeting accuracy, streamline programming, and enhance long-term clinical efficacy.