Subthalamic beta activity and neuroimaging concordance in deep brain stimulation: electrode placement and clinical outcomes.

OBJECTIVE: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established therapy for advanced Parkinson's disease (PD), particularly in managing levodopa-induced motor complications and refractory tremor. The STN is the preferred target for high-frequency DBS, where precise electrode placement is key to optimal outcomes. This study assesses the reliability of local field potential (LFP) recordings in identifying STN electrode placement by comparing them with imaging and atlas based reconstruction methods. METHODS: LFP beta-band activity was recorded 15 days post-surgery in 59 PD patients with DBS implants. Electrode locations were classified as optimal, suboptimal, or outside the STN us-ing neuroimaging reconstructions. Clinical outcomes were assessed at one year using the Unified Parkinson's Disease Rating Scale (UPDRS I-IV). RESULTS: Beta frequency, but not magnitude, differed significantly across placement categories, with optimal electrodes showing higher beta frequency than suboptimal ones. Sensing-identified contacts showed strong concordance with neuroimaging-identified contacts across hemispheres. Op-timal electrode placements were associated with significantly greater improvements in UPDRS III Off and UPDRS IV scores, highlighting the clinical relevance of precise targeting. CONCLUSION: Electrophysiological sensing, when integrated with imaging data, enhances the iden-tification of optimal STN contacts and supports efficient DBS programming. SIGNIFICANCE: Combining LFP recordings with neuroimaging improves programming accuracy and long-term clinical outcomes, supporting their combined use during STN-DB programming.