Neurofeedback-enabled beta power control with a fully implanted DBS system in patients with Parkinson's disease.

• Subthalamic oscillations can be streamed for neurofeedback. • Parkinson patients can control subthalamic oscillations using neurofeedback and improve this control with training time. • DBS electrode-guided neurofeedback is effective even with concurrent stimulation and medication. Parkinsonian motor symptoms are linked to pathologically increased beta oscillations in the basal ganglia. Studies with externalised deep brain stimulation electrodes showed that Parkinson patients were able to rapidly gain control over these pathological basal ganglia signals through neurofeedback. Studies with fully implanted deep brain stimulation systems duplicating these promising results are required to grant transferability to daily application. In this study, seven patients with idiopathic Parkinson's disease and one with familial Parkinson's disease were included. In a postoperative setting, beta oscillations from the subthalamic nucleus were recorded with a fully implanted deep brain stimulation system and converted to a real-time visual feedback signal. Participants were instructed to perform bidirectional neurofeedback tasks with the aim to modulate these oscillations. While receiving regular medication and deep brain stimulation, participants were able to significantly improve their neurofeedback ability and achieved a significant decrease of subthalamic beta power (median reduction of 31% in the final neurofeedback block). We could demonstrate that a fully implanted deep brain stimulation system can provide visual neurofeedback enabling patients with Parkinson's disease to rapidly control pathological subthalamic beta oscillations. Fully-implanted DBS electrode-guided neurofeedback is feasible and can now be explored over extended timespans. [ABSTRACT FROM AUTHOR]