Elevated local field potential power characterizes choreic storms identified by deep brain stimulator event capture.
8 affiliations
- 1Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.
- 2Departments of Cellular & Molecular Medicine, Neurology, and Translational Neuroscience and Program in Genetics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.
- 3Department of Rehabilitation Therapy, Phoenix Children's, Phoenix, AZ, United States.
- 4Functional & Stereotactic Neurosurgery Program, Department of Neurosurgery, Dignity Health Barrow Neurological Institute, Phoenix, AZ, United States.
- 5Center for Translational Science, HonorHealth Research Institute, Scottsdale, AZ, United States.
- 6Departments of Neurology & Neurosurgery, University of Colorado Anschutz, Aurora, CO, United States.
- 7Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's, Phoenix, AZ, United States.
- 8Programs in Biomedical Informatics, Molecular & Cellular Biology, and Neuroscience, College of Health Solutions and School of Life Sciences, Arizona State University, Tempe, AZ, United States.
Abstract
Some patients with hyperkinetic movement disorders may present with a severe and prolonged state of uncontrolled chorea and/or ballism, termed 'choreic storm', causing distress and prompting intervention. These events may be more frequent and severe in patients with childhood-onset movement disorders. Deep brain stimulation (DBS) can be effective for medically refractory dyskinesias including chorea, and the availability of event-based local field potential (LFP) sensing in clinically available devices present an opportunity to better understand the underlying neurophysiology of these episodic phenomena. We analyzed clinical, electrophysiological, and corroborating video data from a patient with a de novo CEP85L mutation (NM_001042475.2, c.2381A>G, p.Y794C) presenting with chorea-predominant dyskinetic cerebral palsy, microcephaly, and intellectual disability. The patient underwent bilateral pallidal DBS for medically refractory symptoms and showed improvement in her baseline chorea. However, choreic storms continued multiple times per week, requiring frequent rescue medications and/or emergency medical intervention. These episodes were associated with autonomic features and variable triggers. Family-initiated LFP event recording supplemented by concurrent video facilitated side-by-side analysis of clinical episodes, revealing elevated LFP power in the theta to low gamma frequencies during choreic storms compared to baseline event recordings. Episode-associated increases in LFP power captured during choreic storms may represent a putative within-patient electrophysiological correlate of these severe episodic exacerbations. Although requiring confirmation and extension in larger series, these observations suggest that adaptive stimulation paradigms could be useful for patients experiencing choreic storms.
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BibTeX
@article{bisarad2026elevated,
title = {{Elevated local field potential power characterizes choreic storms identified by deep brain stimulator event capture.}},
author = {Pritha Bisarad and Kushala Shivaram and Elizabeth H Le and Helen Magee and Sarah Hallgren and Lauren van der Werf and Melissa Duncan and Nicole Lucente and Francisco Ponce and Nicholas Schork and John A Thompson and Michael C Kruer},
journal = {Frontiers in neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1892893},
url = {https://europepmc.org/article/MED/42908514},
note = {CC BY},
}
RIS
TY - JOUR
TI - Elevated local field potential power characterizes choreic storms identified by deep brain stimulator event capture.
AU - Pritha Bisarad
AU - Kushala Shivaram
AU - Elizabeth H Le
AU - Helen Magee
AU - Sarah Hallgren
AU - Lauren van der Werf
AU - Melissa Duncan
AU - Nicole Lucente
AU - Francisco Ponce
AU - Nicholas Schork
AU - John A Thompson
AU - Michael C Kruer
PY - 2026
DA - 2026/10/07
JO - Frontiers in neurology
DO - 10.3389/fneur.2026.1892893
UR - https://europepmc.org/article/MED/42908514
AB - Some patients with hyperkinetic movement disorders may present with a severe and prolonged state of uncontrolled chorea and/or ballism, termed 'choreic storm', causing distress and prompting intervention. These events may be more frequent and severe in patients with childhood-onset movement disorders. Deep brain stimulation (DBS) can be effective for medically refractory dyskinesias including chorea, and the availability of event-based local field potential (LFP) sensing in clinically available devices present an opportunity to better understand the underlying neurophysiology of these episodic phenomena. We analyzed clinical, electrophysiological, and corroborating video data from a patient with a de novo CEP85L mutation (NM_001042475.2, c.2381A>G, p.Y794C) presenting with chorea-predominant dyskinetic cerebral palsy, microcephaly, and intellectual disability. The patient underwent bilateral pallidal DBS for medically refractory symptoms and showed improvement in her baseline chorea. However, choreic storms continued multiple times per week, requiring frequent rescue medications and/or emergency medical intervention. These episodes were associated with autonomic features and variable triggers. Family-initiated LFP event recording supplemented by concurrent video facilitated side-by-side analysis of clinical episodes, revealing elevated LFP power in the theta to low gamma frequencies during choreic storms compared to baseline event recordings. Episode-associated increases in LFP power captured during choreic storms may represent a putative within-patient electrophysiological correlate of these severe episodic exacerbations. Although requiring confirmation and extension in larger series, these observations suggest that adaptive stimulation paradigms could be useful for patients experiencing choreic storms.
SN - 1664-2295
ER -