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Huang PH, Pan YS, Chen SY, Lin SH. Anesthetic Effect on the Subthalamic Nucleus in Microelectrode Recording and Local Field Potential of Parkinson's Disease. Neuromodulation 2024:S1094-7159(24)00073-4. [PMID: 38852085 DOI: 10.1016/j.neurom.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/12/2024] [Accepted: 04/08/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVES Anesthetic agents used during deep brain stimulation (DBS) surgery might interfere with microelectrode recording (MER) and local field potential (LFP) and thus affect the accuracy of surgical target localization. This review aimed to identify the effects of different anesthetic agents on neuronal activity of the subthalamic nucleus (STN) during the MER procedure. MATERIALS AND METHODS We used Medical Subject Heading terms to search the PubMed, EMBASE, EBSCO, and ScienceDirect data bases. MER characteristics were sorted into quantitative and qualitative data types. Quantitative data included the burst index, pause index, firing rate (FR), and interspike interval. Qualitative data included background activity, burst discharge (BD), and anesthetic agent effect. We also categorized the reviewed manuscripts into those describing local anesthesia with sedation (LAWS) and those describing general anesthesia (GA) and compiled the effects of anesthetic agents on MER and LFP characteristics. RESULTS In total, 26 studies on MER were identified, of which 12 used LAWS and 14 used GA. Three studies on LFP also were identified. We found that the FR was preserved under LAWS but tended to be lower under GA, and BD was reduced in both groups. Individually, propofol enhanced BD but was better used for sedation, or the dosage should be minimized in GA. Similarly, low-dose dexmedetomidine sedation did not disturb MER. Opioids could be used as adjunctive anesthetic agents. Volatile anesthesia had the least adverse effect on MER under GA, with minimal alveolar concentration at 0.5. Dexmedetomidine anesthesia did not affect LFP, whereas propofol interfered with the power of LFP. CONCLUSIONS The effects of the tested anesthetics on the STN in MER and LFP of Parkinson's disease varied; however, identifying the STN and achieving a good clinical outcome are possible under controlled anesthetic conditions. For patient comfort, anesthesia should be considered in STN-DBS.
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Affiliation(s)
- Pin-Han Huang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Shen Pan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Shin-Yuan Chen
- Department of Neurosurgery, Hualien Tzu Chi Hospital/Tzu Chi University, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Sheng-Huang Lin
- Department of Neurology, Hualien Tzu Chi Hospital/Tzu Chi University, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
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Zhou Y, Fu S, Du L, Yang Z, Cai Y. General anesthesia versus local anesthesia for deep brain stimulation targeting of STN in Parkinson's disease: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e37955. [PMID: 38669414 PMCID: PMC11049787 DOI: 10.1097/md.0000000000037955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Subthalamic nucleus deep brain stimulation (STN-DBS) is a viable therapeutic for advanced Parkinson's disease. However, the efficacy and safety of STN-DBS under local anesthesia (LA) versus general anesthesia (GA) remain controversial. This meta-analysis aims to compare them using an expanded sample size. METHODS The databases of Embase, Cochrane Library and Medline were systematically searched for eligible cohort studies published between 1967 and 2023. Clinical efficacy was assessed using either Unified Parkinson's Disease Rating Scale (UPDRS) section III scores or levodopa equivalent dosage requirements. Subgroup analyses were performed to assess complications (adverse effects related to stimulation, general neurological and surgical complications, and hardware-related complications). RESULTS Fifteen studies, comprising of 13 retrospective cohort studies and 2 prospective cohort studies, involving a total of 943 patients were included in this meta-analysis. The results indicate that there were no significant differences between the 2 groups with regards to improvement in UPDRS III score or postoperative levodopa equivalent dosage requirement. However, subgroup analysis revealed that patients who underwent GA with intraoperative imaging had higher UPDRS III score improvement compared to those who received LA with microelectrode recording (MER) (P = .03). No significant difference was found in the improvement of UPDRS III scores between the GA group and LA group with MER. Additionally, there were no notable differences in the incidence rates of complications between these 2 groups. CONCLUSIONS Our meta-analysis indicates that STN-DBS performed under GA or LA have similar clinical outcomes and complications. Therefore, GA may be a suitable option for patients with severe symptoms who cannot tolerate the procedure under LA. Additionally, the GA group with intraoperative imaging showed better clinical outcomes than the LA group with MER. A more compelling conclusion would require larger prospective cohort studies with a substantial patient population and extended long follow-up to validate.
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Affiliation(s)
- Yu Zhou
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, P.R. China
| | - Shiyu Fu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, P.R. China
| | - Liangchao Du
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, P.R. China
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Yuxiang Cai
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
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Li Y, Zeng Y, Lin M, Wang Y, Ye Q, Meng F, Cai G, Cai G. β Oscillations of Dorsal STN as a Potential Biomarker in Parkinson's Disease Motor Subtypes: An Exploratory Study. Brain Sci 2023; 13:737. [PMID: 37239209 PMCID: PMC10216185 DOI: 10.3390/brainsci13050737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Parkinson's disease (PD) can be divided into postural instability and difficult gait (PIGD) and tremor dominance (TD) subtypes. However, potential neural markers located in the dorsal ventral side of the subthalamic nucleus (STN) for delineating the two subtypes of PIGD and TD have not been demonstrated. Therefore, this study aimed to investigate the spectral characteristics of PD on the dorsal ventral side. The differences in the β oscillation spectrum of the spike signal on the dorsal and ventral sides of the STN during deep brain stimulation (DBS) were investigated in 23 patients with PD, and coherence analysis was performed for both subtypes. Finally, each feature was associated with the Unified Parkinson's Disease Rating Scale (UPDRS). The β power spectral density (PSD) in the dorsal STN was found to be the best predictor of the PD subtype, with 82.6% accuracy. The PSD of dorsal STN β oscillations was greater in the PIGD group than in the TD group (22.17% vs. 18.22%; p < 0.001). Compared with the PIGD group, the TD group showed greater consistency in the β and γ bands. In conclusion, dorsal STN β oscillations could be used as a biomarker to classify PIGD and TD subtypes, guide STN-DBS treatment, and relate to some motor symptoms.
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Affiliation(s)
- Yongjie Li
- College of Information Engineering, Guangdong University of Technology, Guangzhou 510006, China
| | - Yuqi Zeng
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China; (Y.Z.)
- Fujian Key Laboratory of Molecular Neurology, Institute of Clinical Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350001, China
| | - Mangui Lin
- College of Information Engineering, Guangdong University of Technology, Guangzhou 510006, China
| | - Yingqing Wang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China; (Y.Z.)
- Fujian Key Laboratory of Molecular Neurology, Institute of Clinical Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350001, China
| | - Qinyong Ye
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China; (Y.Z.)
- Fujian Key Laboratory of Molecular Neurology, Institute of Clinical Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350001, China
| | - Fangang Meng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China;
| | - Guofa Cai
- College of Information Engineering, Guangdong University of Technology, Guangzhou 510006, China
| | - Guoen Cai
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China; (Y.Z.)
- Fujian Key Laboratory of Molecular Neurology, Institute of Clinical Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou 350001, China
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Bos MJ, Buhre W, Temel Y, Joosten EAJ, Absalom AR, Janssen MLF. Effect of Anesthesia on Microelectrode Recordings During Deep Brain Stimulation Surgery: A Narrative Review. J Neurosurg Anesthesiol 2021; 33:300-307. [PMID: 31913866 DOI: 10.1097/ana.0000000000000673] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/04/2019] [Indexed: 12/31/2022]
Abstract
Deep brain stimulation (DBS) is an effective surgical treatment for patients with various neurological and psychiatric disorders. Clinical improvements rely on careful patient selection and accurate electrode placement. A common method for target localization is intraoperative microelectrode recording (MER). To facilitate MER, DBS surgery is traditionally performed under local or regional anesthesia. However, sedation or general anesthesia is sometimes needed for patients who are unable to tolerate the procedure fully awake because of severe motor symptoms, psychological distress, pain, or other forms of discomfort. The effect of anesthetic drugs on MER is controversial but likely depends on the type and dose of a particular anesthetic agent, underlying disease, and surgical target. In this narrative review, we provide an overview of the current literature on the anesthetic drugs most often used for sedation and anesthesia during DBS surgery, with a focus on their effects on MERs.
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Affiliation(s)
- Michaël J Bos
- Departments of Anesthesiology and Pain Medicine
- School for Mental Health and Neuroscience, Maastricht University, Maastricht
| | | | - Yasin Temel
- Neurosurgery
- School for Mental Health and Neuroscience, Maastricht University, Maastricht
| | - Elbert A J Joosten
- Departments of Anesthesiology and Pain Medicine
- School for Mental Health and Neuroscience, Maastricht University, Maastricht
| | - Anthony R Absalom
- Department of Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcus L F Janssen
- Neurology
- Clinical Neurophysiology, Maastricht University Medical Center
- School for Mental Health and Neuroscience, Maastricht University, Maastricht
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Jiang N, Ling YT, Yang C, Liu Y, Xian WB, Zhang LN, Guo QQ, Jin XY, Wu B, Zhang CM, Chen L, Zhang ZG, Liu JL. Optimized Propofol Anesthesia Increases Power of Subthalamic Neuronal Activity in Patients with Parkinson's Disease Undergoing Deep Brain Stimulation. Neurol Ther 2021; 10:785-802. [PMID: 34095990 PMCID: PMC8571439 DOI: 10.1007/s40120-021-00259-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/22/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Propofol is a general anesthetic option for deep brain stimulation (DBS) of the subthalamic nucleus (STN) of patients with Parkinson's disease (PD). However, its effects on STN activity and neuropsychological outcomes are controversial. The optimal propofol anesthesia for asleep DBS is unknown. This study investigated the safety and effectiveness of an optimized propofol anesthesia regimen in asleep DBS. Methods This retrospective study enrolled 68 PD patients undergoing bilateral STN-DBS surgery. All patients received local scalp anesthesia, with (asleep group, n = 35) or without (awake group, n = 33) propofol-remifentanil general anesthesia by target-controlled infusion under electroencephalogram monitoring. The primary outcome was subthalamic neuronal spiking characterization during microelectrode recording. The secondary outcomes were clinical outcomes including motor, cognition, mind, sleep, and quality of life at 6 months. Results Significantly increased delta and theta power were obtained under propofol anesthesia (awake vs. asleep group, mean ± standard deviation; delta: 31.97 ± 9.87 vs. 39.77 ± 10.56, p < 0.01; theta: 21.09 ± 5.55 vs. 24.82 ± 6.63, p = 0.01). After excluding the influence of confounding factors of age and preoperative motor scores, there was a statistically significant influence on the delta, theta, and alpha power of STN neuronal activity under different anesthesia regimens (delta: β = 2.64, p < 0.01; theta: β = 2.11, p < 0.01; alpha: β = 1.42, p = 0.01). There were no differences in modified burst index, firing rate, tract numbers of microelectrode recording, and other clinical outcomes between the two groups. Conclusion Optimized propofol anesthesia enhanced the delta, theta, and alpha power in STN compared with the awake technique and likely contributed to target recognition under propofol anesthesia. These results demonstrate that propofol is suitable, but needs to be optimized, for asleep STN-DBS. Trial Registration Chinese Clinical Trial Registry Identification number: ChiCTR2100045942. Registered 29 April 2021–Retrospectively registered Supplementary Information The online version contains supplementary material available at 10.1007/s40120-021-00259-y.
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Affiliation(s)
- Nan Jiang
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yu-Ting Ling
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Chao Yang
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yi Liu
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Wen-Biao Xian
- Department of Neurology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Li-Nan Zhang
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Qian-Qian Guo
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Xing-Yi Jin
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, 518060, Guangdong Province, People's Republic of China
| | - Bin Wu
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Chang-Ming Zhang
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Ling Chen
- Department of Neurology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Zhi-Guo Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, 518060, Guangdong Province, People's Republic of China
| | - Jin-Long Liu
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China.
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Desflurane and sevoflurane differentially affect activity of the subthalamic nucleus in Parkinson's disease. Br J Anaesth 2020; 126:477-485. [PMID: 33160604 DOI: 10.1016/j.bja.2020.09.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Desflurane and sevoflurane are commonly used during inhalational anaesthesia, but few studies have investigated their effects on deep cerebral neuronal activity. In addition, the association between subthalamic nucleus (STN) neurophysiology and general anaesthesia induced by volatile anaesthetics are not yet identified. This study aimed to identify differences in neurophysiological characteristics of the STN during comparable minimal alveolar concentration (MAC) desflurane and sevoflurane anaesthesia for deep brain stimulation (DBS) in patients with Parkinson's disease. METHODS Twelve patients with similar Parkinson's disease severity received desflurane (n=6) or sevoflurane (n=6) during DBS surgery. We obtained STN spike firing using microelectrode recording at 0.5-0.6 MAC and compared firing rate, power spectral density, and coherence. RESULTS Neuronal firing rate was lower with desflurane (47.4 [26.7] Hz) than with sevoflurane (63.9 [36.5] Hz) anaesthesia (P<0.001). Sevoflurane entrained greater gamma oscillation power than desflurane (62.9% [0.9%] vs 57.0% [1.5%], respectively; P=0.002). There was greater coherence in the theta band of the desflurane group compared with the sevoflurane group (13% vs 6%, respectively). Anaesthetic choice did not differentially influence STN mapping accuracy or the clinical outcome of DBS electrode implantation. CONCLUSIONS Desflurane and sevoflurane produced distinct neurophysiological profiles in humans that may be associated with their analgesic and hypnotic actions.
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Park HR, Lim YH, Song EJ, Lee JM, Park K, Park KH, Lee WW, Kim HJ, Jeon B, Paek SH. Bilateral Subthalamic Nucleus Deep Brain Stimulation under General Anesthesia: Literature Review and Single Center Experience. J Clin Med 2020; 9:jcm9093044. [PMID: 32967337 PMCID: PMC7564882 DOI: 10.3390/jcm9093044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/13/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
Bilateral subthalamic nucleus (STN) Deep brain stimulation (DBS) is a well-established treatment in patients with Parkinson's disease (PD). Traditionally, STN DBS for PD is performed by using microelectrode recording (MER) and/or intraoperative macrostimulation under local anesthesia (LA). However, many patients cannot tolerate the long operation time under LA without medication. In addition, it cannot be even be performed on PD patients with poor physical and neurological condition. Recently, it has been reported that STN DBS under general anesthesia (GA) can be successfully performed due to the feasible MER under GA, as well as the technical advancement in direct targeting and intraoperative imaging. The authors reviewed the previously published literature on STN DBS under GA using intraoperative imaging and MER, focused on discussing the technique, clinical outcome, and the complication, as well as introducing our single-center experience. Based on the reports of previously published studies and ours, GA did not interfere with the MER signal from STN. STN DBS under GA without intraoperative stimulation shows similar or better clinical outcome without any additional complication compared to STN DBS under LA. Long-term follow-up with a large number of the patients would be necessary to validate the safety and efficacy of STN DBS under GA.
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Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea;
| | - Yong Hoon Lim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea; (Y.H.L.); (E.J.S.)
| | - Eun Jin Song
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea; (Y.H.L.); (E.J.S.)
| | - Jae Meen Lee
- Department of Neurosurgery, Pusan National University Hospital, Busan 49241, Korea;
| | - Kawngwoo Park
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon 21565, Korea;
| | - Kwang Hyon Park
- Department of Neurosurgery, Chuungnam National University Sejong Hospital, Sejong 30099, Korea;
| | - Woong-Woo Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea;
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea; (H.-J.K.); (B.J.)
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea; (H.-J.K.); (B.J.)
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea; (Y.H.L.); (E.J.S.)
- Correspondence: ; Tel.: +82-22-072-2876
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Abstract
Abstract
Background
General anesthetics-induced changes of electrical oscillations in the basal ganglia may render the identification of the stimulation targets difficult. The authors hypothesized that while sevoflurane anesthesia entrains coherent lower frequency oscillations, it does not affect the identification of the subthalamic nucleus and clinical outcome.
Methods
A cohort of 19 patients with Parkinson’s disease with comparable disability underwent placement of electrodes under either sevoflurane general anesthesia (n = 10) or local anesthesia (n = 9). Microelectrode recordings during targeting were compared for neuronal spiking characteristics and oscillatory dynamics. Clinical outcomes were compared at 5-yr follow-up.
Results
Under sevoflurane anesthesia, subbeta frequency oscillations predominated (general vs. local anesthesia, mean ± SD; delta: 13 ± 7.3% vs. 7.8 ± 4.8%; theta: 8.4 ± 4.1% vs. 3.9 ± 1.6%; alpha: 8.1 ± 4.1% vs. 4.8 ± 1.5%; all P < 0.001). In addition, distinct dorsolateral beta and ventromedial gamma oscillations were detected in the subthalamic nucleus solely in awake surgery (mean ± SD; dorsal vs. ventral beta band power: 20.5 ± 6.6% vs. 15.4 ± 4.3%; P < 0.001). Firing properties of subthalamic neurons did not show significant difference between groups. Clinical outcomes with regard to improvement in motor and psychiatric symptoms and adverse effects were comparable for both groups. Tract numbers of microelectrode recording, active contact coordinates, and stimulation parameters were also equivalent.
Conclusions
Sevoflurane general anesthesia decreased beta-frequency oscillations by inducing coherent lower frequency oscillations, comparable to the pattern seen in the scalp electroencephalogram. Nevertheless, sevoflurane-induced changes in electrical activity patterns did not reduce electrode placement accuracy and clinical effect. These observations suggest that microelectrode-guided deep brain stimulation under sevoflurane anesthesia is a feasible clinical option.
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
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Wardell K, Zsigmond P, Hemm S. A System for Combined Laser Doppler Flowmetry and Microelectrode Recording during Deep Brain Stimulation Implantation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3758-3761. [PMID: 31946692 DOI: 10.1109/embc.2019.8856373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Microelectrode recording (MER) and intraoperative test stimulations are commonly used during stereotactic implantation of deep brain stimulation (DBS) electrodes but they can increase the risk of hemorrhage. The aim of the study is to present and evaluate a system combining laser Doppler flowmetry (LDF) and MER. An optical probe was designed with an inner metal tube for the microelectrode. Calibration of the MER-LDF probe in a standard microsphere solution showed expected LDF pattern. No interferences of the MER probe with the LDF signals could be observed. LDF was also acquired in one Parkinson patient undergoing DBS implantation. LDF data were obtained along the precalculated trajectory i.e. from cortex towards the target in the subthalamic nucleus (STN). Results demonstrated the technical feasibility of the combined MER-LDF probe during in-vitro experiences and in one patient. The perfusion signal representing the microcirculation showed stable values with clear peaks from each heartbeat. This agreed with previous investigation using an optical probe without the MER function. Due to the forward-looking probe design, this new technology has a high potential to avoid vessels during MER recording. In addition, it could be possible to detect changes in microcirculatory blood flow during stimulation.
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Optimization of the KNN Supervised Classification Algorithm as a Support Tool for the Implantation of Deep Brain Stimulators in Patients with Parkinson's Disease. ENTROPY 2019; 21:e21040346. [PMID: 33267060 PMCID: PMC7514830 DOI: 10.3390/e21040346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 11/16/2022]
Abstract
Deep Brain Stimulation (DBS) of the Subthalamic Nuclei (STN) is the most used surgical treatment to improve motor skills in patients with Parkinson’s Disease (PD) who do not adequately respond to pharmacological treatment, or have related side effects. During surgery for the implantation of a DBS system, signals are obtained through microelectrodes recordings (MER) at different depths of the brain. These signals are analyzed by neurophysiologists to detect the entry and exit of the STN region, as well as the optimal depth for electrode implantation. In the present work, a classification model is developed and supervised by the K-nearest neighbour algorithm (KNN), which is automatically trained from the 18 temporal features of MER registers of 14 patients with PD in order to provide a clinical support tool during DBS surgery. We investigate the effect of different standardizations of the generated database, the optimal definition of KNN configuration parameters, and the selection of features that maximize KNN performance. The results indicated that KNN trained with data that was standardized per cerebral hemisphere and per patient presented the best performance, achieving an accuracy of 94.35% (p < 0.001). By using feature selection algorithms, it was possible to achieve 93.5% in accuracy in selecting a subset of six features, improving computation time while processing in real time.
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Malekmohammadi M, Sparks H, AuYong N, Hudson A, Pouratian N. Propofol Anesthesia Precludes LFP-Based Functional Mapping of Pallidum during DBS Implantation. Stereotact Funct Neurosurg 2018; 96:249-258. [PMID: 30196280 DOI: 10.1159/000492231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/18/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIMS There are reports that microelectrode recording (MER) can be performed under certain anesthetized conditions for functional confirmation of the optimal deep brain stimulation (DBS) target. However, it is generally accepted that anesthesia affects MER. Due to a potential role of local field potentials (LFPs) in DBS functional mapping, we characterized the effect of propofol on globus pallidus interna (GPi) and externa (GPe) LFPs in Parkinson disease (PD) patients. METHODS We collected LFPs in 12 awake and anesthetized PD patients undergoing DBS implantation. Spectral power of β (13-35 Hz) and high-frequency oscillations (HFOs: 200-300 Hz) was compared across the pallidum. RESULTS Propofol suppressed GPi power by > 20 Hz while increasing power at lower frequencies. A similar power shift was observed in GPe; however, power in the high β range (20-35 Hz) increased with propofol. Before anesthesia both β and HFO activity were significantly greater at the GPi (χ2 = 20.63 and χ2 = 48.81, p < 0.0001). However, during anesthesia, we found no significant difference across the pallidum (χ2 = 0.47, p = 0.79, and χ2 = 4.11, p = 0.12). CONCLUSION GPi and GPe are distinguishable using LFP spectral profiles in the awake condition. Propofol obliterates this spectral differentiation. Therefore, LFP spectra cannot be relied upon in the propofol-anesthetized state for functional mapping during DBS implantation.
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Affiliation(s)
- Mahsa Malekmohammadi
- Department of Neurosurgery, University of California, Los Angeles, California, USA
| | - Hiro Sparks
- Department of Neurosurgery, University of California, Los Angeles, California, USA
| | - Nicholas AuYong
- Department of Neurosurgery, University of California, Los Angeles, California, USA
| | - Andrew Hudson
- Department of Anesthesiology, University of California, Los Angeles, California, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles, California, USA.,Neuroscience Interdepartmental Program, University of California, Los Angeles, California, USA.,Brain Research Institute, University of California, Los Angeles, California, USA
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