Invasive Approach to Model Human Cortex-Basal Ganglia Action-Regulating Networks

Inclusion criteria

• Age > 18
• Rigid-akinetic subtype of Parkinson's disease, diagnosed by a movement disorders neurologist
• Clinical indications, as deemed by a multidisciplinary team of neurologists and neurosurgeons, for deep brain stimulation surgery, including motor fluctuations, difficult-to-control-dyskinesias, unpredictable off-times, and/or dystonia
• Preoperative MRI without cortical or subdural adhesions or vascular abnormalities
• Subject is medically fit for surgical intervention, as deemed by a primary care physician

Exclusion criteria

• Inability or unwillingness to tolerate 20 minutes and up to 40 minutes of additional operative time
• Patient with history of secondary Parkinsonism, stroke, or progressive central nervous system disease other than Parkinson's disease.
• Subject is at high risk for surgical complications such as active systemic infection, coagulation disorders (such as the use of anti-thrombotic therapies) or platelet count below 100,000.
• Subject is taking chronic anticoagulants or antiplatelet agent or subject has an abnormally elevated preoperative coagulation profile (either (Partial Thromboplastin Time) PTT or prothrombin time/INR).
• Patients with recent use (within one week) of anticoagulant or antiplatelet agent use
• Subject has history of bleeding or immune compromise.
• Subject has history of implant-related infection.
• Subject has a prior history of seizures or epilepsy.
• Subject has a clinically significant or unstable medical condition including uncontrolled systemic hypertension with values above 170/100; cardiac or pulmonary disease; uncorrected coagulation abnormalities; diabetes; or any condition that would render the patient unable to safely cooperate with the study tests as judged by the screening physician.
• Subject has a significant abnormality on preoperative brain MRI
• Subject has had prior craniotomy or brain surgery.
• Subject has significant memory impairment (based on Montreal Cognitive Assessment (MoCA) < 23).
• Subject has a disease or condition that prevents understanding or communication of informed consent, study demands, and testing protocols, including:

• Cognitive decline including diagnosed forms of dementia and/or progressive neurologic disease
• Does not speak a principal language associated with the region
• Hearing loss that prevents adequate communication with researchers.
• Subject has moderate or severe depression (HAMD ≥ 17)
• Subject is implanted with any neuromodulation device in the head including, but not limited to cochlear implant, deep brain stimulator, or auditory brain implant.