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Cheyuo C, Vetkas A, Sarica C, Kalia SK, Hodaie M, Lozano AM. Comprehensive characterization of intracranial hemorrhage in deep brain stimulation: a systematic review of literature from 1987 to 2023. J Neurosurg 2024:1-13. [PMID: 38518284 DOI: 10.3171/2024.1.jns232385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/11/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an effective treatment for medically refractory movement disorders and other neurological conditions. To comprehensively characterize the prevalence, locations, timing of detection, clinical effects, and risk factors of DBS-related intracranial hemorrhage (ICH), the authors performed a systematic review of the published literature. METHODS PubMed, EMBASE, and Web of Science were searched using 2 concepts: cerebral hemorrhage and brain stimulation, with filters for English, human studies, and publication dates 1980-2023. The inclusion criteria were the use of DBS intervention for any human neurological condition, with documentation of hemorrhagic complications by location and clinical effect. Studies with non-DBS interventions, no documentation of hemorrhage outcome, patient cohorts of ≤ 10, and pediatric patients were excluded. The risk of bias was assessed using Centre for Evidence-Based Medicine Levels of Evidence. The authors performed proportional meta-analysis for ICH prevalence. RESULTS A total of 63 studies, with 13,056 patients, met the inclusion criteria. The prevalence of ICH was 2.9% (fixed-effects model, 95% CI 2.62%-3.2%) per patient and 1.6% (random-effects model, 95% CI 1.34%-1.87%) per DBS lead, with 49.6% being symptomatic. The ICH rates did not change with time. ICH most commonly occurred around the DBS lead, with 16% at the entry point, 31% along the track, and 7% at the target. Microelectrode recording (MER) during DBS was associated with increased ICH rate compared to DBS without MER (3.5 ± 2.2 vs 2.1 ± 1.4; p[T ≤ t] 1-tail = 0.038). Other reported ICH risk factors include intraoperative systolic blood pressure > 140 mm Hg, sulcal DBS trajectories, and multiple microelectrode insertions. Sixty percent of ICH was detected at 24 hours postoperatively and 27% intraoperatively. The all-cause mortality rate of DBS was 0.4%, with ICH accounting for 22% of deaths. Single-surgeon DBS experience showed a weak inverse correlation (r = -0.27, p = 0.2189) between the rate of ICH per lead and the number of leads implanted per year. CONCLUSIONS This study provides level III evidence that MER during DBS is a risk factor for ICH. Other risk factors include intraoperative systolic blood pressure > 140 mm Hg, sulcal trajectories, and multiple microelectrode insertions. Avoidance of these risk factors may decrease the rate of ICH.
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Affiliation(s)
- Cletus Cheyuo
- 1Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
- 2Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Artur Vetkas
- 2Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
- 3Department of Neurosurgery, Neurology Clinic, Tartu University Hospital, University of Tartu, Estonia; and
| | - Can Sarica
- 2Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Suneil K Kalia
- 2Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
- 4Krembil Research Institute, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- 2Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
- 4Krembil Research Institute, Toronto, Ontario, Canada
| | - Andres M Lozano
- 2Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
- 4Krembil Research Institute, Toronto, Ontario, Canada
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Grossen A, Shi HH, Schenk M, Stocco A, Ramsey J, Sahgal S, Conner AK, Desai VR. Deep brain stimulation in a pediatric dystonia patient with cochlear implants and mitochondrial disorder: novel application of a frameless stereotactic system and navigating the anesthesia choice and neurosurgical complexities. Illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23128. [PMID: 37581590 PMCID: PMC10555587 DOI: 10.3171/case23128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/12/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND This report presents a case of medically refractory dystonia in a pediatric patient successfully treated with bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) while under general anesthesia by using microelectrode recordings (MERs) with intraoperative computed tomography (CT). OBSERVATIONS The patient was an 18-year-old female with primary dystonia secondary to mitochondrial Leigh syndrome. Her past medical history was significant for complex partial epilepsy and hearing loss treated with cochlear implants. Her cochlear implants precluded anatomical targeting via magnetic resonance imaging. Additionally, the patient could not tolerate awake surgery with MER. The decision was made to proceed with bilateral STN DBS with intraoperative CT with the patient under general anesthesia. The patient's cochlear implants made standard frame placement difficult, so navigation was performed with the Nexframe system. Recordings were obtained with the patient under general anesthesia with ketamine, dexmedetomidine, and remifentanil. At the 3- and 6-month follow-ups, the patient demonstrated marked improvement in dystonia without neurological complications. LESSONS This is the first case of dystonia secondary to Leigh syndrome treated with DBS. Additionally, the authors describe the novel use of the Nexframe for DBS lead placement in a pediatric patient. This demonstrates that STN DBS with the use of MER and intraoperative CT can be a safe and effective method of treating dystonia in certain pediatric patients.
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Affiliation(s)
- Audrey Grossen
- Departments of1Neurosurgery and
- 2Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, Oklahoma
| | - Helen H Shi
- Departments of1Neurosurgery and
- 2Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, Oklahoma
| | - Mallory Schenk
- 3Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Amber Stocco
- 4Department of Neurology, Section of Pediatric Neurology, Integris Health, Oklahoma City, Oklahoma
| | | | - Suneet Sahgal
- 6Adolescent and Child Psychiatry, Bethany Children's Health Center, Bethany, Oklahoma
| | | | - Virendra R Desai
- Departments of1Neurosurgery and
- 2Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, Oklahoma
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gulberti A, Wagner JR, Horn MA, Reuss JH, Schaper M, Koeppen JA, Pinnschmidt HO, Westphal M, Engel AK, Gerloff C, Sharott A, Hamel W, Moll CKE, Pötter-Nerger M. Subthalamic and nigral neurons are differentially modulated during parkinsonian gait. Brain 2023:7024802. [PMID: 36730026 DOI: 10.1093/brain/awad006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/01/2022] [Accepted: 12/22/2022] [Indexed: 02/03/2023] Open
Abstract
The parkinsonian gait disorder and freezing of gait are therapeutically demanding symptoms with considerable impact on quality of life. The aim of this study was to assess the role of subthalamic and nigral neurons in the parkinsonian gait control using intraoperative microelectrode recordings of basal ganglia neurons during a supine stepping task. 12 male patients (56±7 years) suffering from moderate idiopathic Parkinson's disease (disease duration 10±3 years, Hoehn & Yahr stage 2) participated in the study. After 10 seconds resting period, stepping at self-paced speed for 35 seconds was followed by short intervals of stepping in response to random "start" and "stop" cues. Single- and multi-unit activity was analysed offline in relation to different aspects of the stepping task (attentional "start" and "stop" cues, heel strikes, stepping irregularities) in terms of firing frequency, firing pattern, and oscillatory activity. Subthalamic nucleus and the substantia nigra neurons responded to different aspects of the stepping task. 24% of the subthalamic nucleus neurons exhibited movement-related activity modulation as an increase of the firing rate, suggesting a predominant role of the subthalamic nucleus in motor aspects of the task, while 8% of subthalamic nucleus neurons showed a modulation in response to the attentional cues. In contrast, responsive substantia nigra neurons showed activity changes exclusively associated with attentional aspects of the stepping task (15%). The firing pattern of subthalamic nucleus neurons revealed gait-related firing regulation and a drop of beta oscillations during regular stepping performance. During freezing episodes instead, there was a rise of beta oscillatory activity. This study shows for the first time specific, task-related, subthalamic nucleus and substantia nigra single unit activity during gait-like movements in humans with differential roles in motor and attentional control of gait. The emergence of perturbed firing patterns in the subthalamic nucleus indicates a disturbed information transfer within the gait network, resulting in freezing of gait.
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Affiliation(s)
- Alessandro Gulberti
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.,Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Jonas R Wagner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Martin A Horn
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Joacob H Reuss
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Miriam Schaper
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Johannes A Koeppen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Hans O Pinnschmidt
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Andreas K Engel
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Andrew Sharott
- MRC Brain Network Dynamics Unit, Department of Pharmacology, University of Oxford, Oxford OX1 3TH, UK
| | - Wolfgang Hamel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christian K E Moll
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - M Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Pastor J, Vega-Zelaya L, Martín-Abad E. Atypical Extracellular Action Potentials from Posteromedial Hypothalamus in Anesthetized Humans. FRONT BIOSCI-LANDMRK 2022; 27:155. [PMID: 35638422 DOI: 10.31083/j.fbl2705155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/16/2022] [Accepted: 04/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND We obtained microelectrode recordings from four patients with intractable aggressivity who underwent surgery at posteromedial hypothalamus under general anaesthesia. We described two general types of extracellular action potentials (EAPs): typical/canonical and atypical. METHODS We analysed 337 units and 67 traces, which were characterized by the mean action potential (mAP). For the first phase, depolarization and repolarization, we computed amplitudes (VFP, VDep and VRep) and durations (dFP, dDep and dRep), maximum and minimum values of the first derivative (dVmax, dVmin), and amplitude and duration ratios. RESULTS Most of the canonical mAPs were positive (81.1%). EAPs with atypical mean action potentials (amAPs) were recorded in 42/337 cases. Only 35.6% of mAPs showed 2 phases. We identified the following types: N1P1N2 (38.3%), P1N1 (35.9%), amAP (12.5%), P1P2N1 (12.2%), N1P1 (4.7%), P1N1P2 (4.1%) and N1N2P1 (3.2%). We can define the properties of canonical forms as those units with (i) at least two opposite phases; (ii) VDep∈[1.2,2.7]×|VRep| and strongly related by this function VRep=-0.56(±0.01)VDep-1.83(±0.79); (iii) a very strong relationship between dVmax and dVmin, given by the equation dVmin=-0.91(±0.03)dVmax-0.37(±0.12), both of which were included in the depolarization phase; (iv) related with VDep by the equation dVmax=0.08(±0.001)VDep-0.28(±0.14); and (v) dDep~0.38dRep. However, the first phase does not pertain to the same dynamic process responsible for depolarization and repolarization. CONCLUSIONS Atypical units are described here for the first time and are true EAPs that differ strikingly from canonical forms. To date, they have been observed only in the hypothalamus, but future research is needed to assess their existence in other brain structures.
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Affiliation(s)
- Jesús Pastor
- Clinical Neurophysiology, Hospital Universitario La Princesa, 28006 Madrid, Spain.,Fundación de Investigación Biomédica, Hospital Universitario La Princesa, 28006 Madrid, Spain
| | - Lorena Vega-Zelaya
- Clinical Neurophysiology, Hospital Universitario La Princesa, 28006 Madrid, Spain.,Fundación de Investigación Biomédica, Hospital Universitario La Princesa, 28006 Madrid, Spain
| | - Elena Martín-Abad
- Clinical Neurophysiology, Hospital Universitario La Princesa, 28006 Madrid, Spain.,Fundación de Investigación Biomédica, Hospital Universitario La Princesa, 28006 Madrid, Spain.,PhD Program in Neuroscience, Autonoma de Madrid University-Cajal Institute, 28029 Madrid, Spain
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Sirica D, Hewitt AL, Tarolli CG, Weber MT, Zimmerman C, Santiago A, Wensel A, Mink JW, Lizárraga KJ. Neurophysiological biomarkers to optimize deep brain stimulation in movement disorders. Neurodegener Dis Manag 2021; 11:315-328. [PMID: 34261338 PMCID: PMC8977945 DOI: 10.2217/nmt-2021-0002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Intraoperative neurophysiological information could increase accuracy of surgical deep brain stimulation (DBS) lead placement. Subsequently, DBS therapy could be optimized by specifically targeting pathological activity. In Parkinson’s disease, local field potentials (LFPs) excessively synchronized in the beta band (13–35 Hz) correlate with akinetic-rigid symptoms and their response to DBS therapy, particularly low beta band suppression (13–20 Hz) and high frequency gamma facilitation (35–250 Hz). In dystonia, LFPs abnormally synchronize in the theta/alpha (4–13 Hz), beta and gamma (60–90 Hz) bands. Phasic dystonic symptoms and their response to DBS correlate with changes in theta/alpha synchronization. In essential tremor, LFPs excessively synchronize in the theta/alpha and beta bands. Adaptive DBS systems will individualize pathological characteristics of neurophysiological signals to automatically deliver therapeutic DBS pulses of specific spatial and temporal parameters.
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Affiliation(s)
- Daniel Sirica
- Motor Physiology & Neuromodulation Program, Division of Movement Disorders, Department of Neurology, University of Rochester, Rochester, NY 14618, USA
| | - Angela L Hewitt
- Motor Physiology & Neuromodulation Program, Division of Movement Disorders, Department of Neurology, University of Rochester, Rochester, NY 14618, USA.,Division of Child Neurology, Department of Neurology, University of Rochester, Rochester, NY 14623, USA
| | - Christopher G Tarolli
- Motor Physiology & Neuromodulation Program, Division of Movement Disorders, Department of Neurology, University of Rochester, Rochester, NY 14618, USA.,Center for Health & Technology (CHeT), University of Rochester, Rochester, NY 14642, USA
| | - Miriam T Weber
- Motor Physiology & Neuromodulation Program, Division of Movement Disorders, Department of Neurology, University of Rochester, Rochester, NY 14618, USA
| | - Carol Zimmerman
- Motor Physiology & Neuromodulation Program, Division of Movement Disorders, Department of Neurology, University of Rochester, Rochester, NY 14618, USA
| | - Aida Santiago
- Motor Physiology & Neuromodulation Program, Division of Movement Disorders, Department of Neurology, University of Rochester, Rochester, NY 14618, USA
| | - Andrew Wensel
- Motor Physiology & Neuromodulation Program, Division of Movement Disorders, Department of Neurology, University of Rochester, Rochester, NY 14618, USA.,Department of Neurosurgery, University of Rochester, Rochester, NY 14618, USA
| | - Jonathan W Mink
- Motor Physiology & Neuromodulation Program, Division of Movement Disorders, Department of Neurology, University of Rochester, Rochester, NY 14618, USA.,Division of Child Neurology, Department of Neurology, University of Rochester, Rochester, NY 14623, USA
| | - Karlo J Lizárraga
- Motor Physiology & Neuromodulation Program, Division of Movement Disorders, Department of Neurology, University of Rochester, Rochester, NY 14618, USA.,Center for Health & Technology (CHeT), University of Rochester, Rochester, NY 14642, USA
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Bos MJ, de Korte-de Boer D, Alzate Sanchez AM, Duits A, Ackermans L, Temel Y, Absalom AR, Buhre WF, Roberts MJ, Janssen MLF. Impact of Procedural Sedation on the Clinical Outcome of Microelectrode Recording Guided Deep Brain Stimulation in Patients with Parkinson's Disease. J Clin Med 2021; 10:1557. [PMID: 33917205 PMCID: PMC8068017 DOI: 10.3390/jcm10081557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Subthalamic nucleus (STN) deep brain stimulation (DBS) has become a routine treatment of advanced Parkinson's disease (PD). DBS surgery is commonly performed under local anesthesia (LA) to obtain reliable microelectrode recordings. However, procedural sedation and/or analgesia (PSA) is often desirable to improve patient comfort. The impact of PSA in addition to LA on outcome is largely unknown. Therefore, we performed an observational study to assess the effect of PSA compared to LA alone during STN DBS surgery on outcome in PD patients. METHODS Seventy PD patients (22 under LA, 48 under LA + PSA) scheduled for STN DBS implantation were included. Dexmedetomidine, clonidine or remifentanil were used for PSA. The primary outcome was the change in Movement Disorders Society Unified Parkinson's Disease Rating Score III (MDS-UPDRS III) and levodopa equivalent daily dosage (LEDD) between baseline, one month before surgery, and twelve months postoperatively. Secondary outcome measures were motor function during activities of daily living (MDS-UPDRS II), cognitive alterations and surgical adverse events. Postoperative assessment was conducted in "on" stimulation and "on" medication conditions. RESULTS At twelve months follow-up, UPDRS III and UPDRS II scores in "on" medication conditions were similar between the LA and PSA groups. The two groups showed a similar LEDD reduction and an equivalent decline in executive function measured by the Stroop Color-Word Test, Trail Making Test-B, and verbal fluency. The incidence of perioperative and postoperative adverse events was similar between groups. CONCLUSION This study demonstrates that PSA during STN DBS implantation surgery in PD patients was not associated with differences in motor and non-motor outcome after twelve months compared with LA only.
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Affiliation(s)
- Michael J. Bos
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (D.d.K.-d.B.); (W.F.B.)
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (A.M.A.S.); (A.D.); (Y.T.); (M.L.F.J.)
| | - Dianne de Korte-de Boer
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (D.d.K.-d.B.); (W.F.B.)
| | - Ana Maria Alzate Sanchez
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (A.M.A.S.); (A.D.); (Y.T.); (M.L.F.J.)
| | - Annelien Duits
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (A.M.A.S.); (A.D.); (Y.T.); (M.L.F.J.)
- Department of Medical Psychology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Linda Ackermans
- Department of Neurosurgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands;
| | - Yasin Temel
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (A.M.A.S.); (A.D.); (Y.T.); (M.L.F.J.)
- Department of Neurosurgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands;
| | - Anthony R. Absalom
- Department of Anesthesiology, University Medical Center Groningen, Groningen University, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Wolfgang F. Buhre
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (D.d.K.-d.B.); (W.F.B.)
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (A.M.A.S.); (A.D.); (Y.T.); (M.L.F.J.)
| | - Mark J. Roberts
- Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
| | - Marcus L. F. Janssen
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (A.M.A.S.); (A.D.); (Y.T.); (M.L.F.J.)
- Department of Clinical Neurophysiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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Pastor J, Vega-Zelaya L. Features of Action Potentials from Identified Thalamic Nuclei in Anesthetized Patients. Brain Sci 2020; 10:E1002. [PMID: 33348660 DOI: 10.3390/brainsci10121002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/24/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022] Open
Abstract
Our objective was to describe the electrophysiological properties of the extracellular action potential (AP) picked up through microelectrode recordings (MERs). Five patients were operated under general anesthesia for centromedian deep brain stimulation (DBS). APs from the same cell were pooled to obtain a mean AP (mAP). The amplitudes and durations for all 2/3 phases were computed from the mAP, together with the maximum (dVmax) and minimum (dVmin) values of the first derivative, as well as the slopes of different phases during repolarization. The mAPs are denominated according to the phase polarity (P/N for positive/negative). We obtained a total of 1109 mAPs, most of the positive (98.47%) and triphasic (93.69%) with a small P/N deflection (Vphase1) before depolarization. The percentage of the different types of mAPs was different for the nuclei addressed. The relationship between dVmax and the depolarizing phase is specific. The descending phase of the first derivative identified different phases during the repolarizing period. We observed a high correlation between Vphase1 and the amplitudes of either depolarization or repolarization phases. Human thalamic nuclei differ in their electrophysiological properties of APs, even under general anesthesia. Capacitive current, which is probably responsible for Vphase1, is very common in thalamic APs. Moreover, subtle differences during repolarization are neuron-specific.
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Coelli S, Levi V, Del Vecchio Del Vecchio J, Mailland E, Rinaldo S, Eleopra R, Bianchi AM. An intra-operative feature-based classification of microelectrode recordings to support the subthalamic nucleus functional identification during deep brain stimulation surgery. J Neural Eng 2020; 18. [PMID: 33202390 DOI: 10.1088/1741-2552/abcb15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/17/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The Subthalamic Nucleus (STN) is the most selected target for the placement of the Deep Brain Stimulation (DBS) electrode to treat Parkinson's disease. Its identification is a delicate and challenging task which is based on the interpretation of the STN functional activity acquired through microelectrode recordings (MER). Aim of this work is to explore the potentiality of a set of twenty-five features to build a classification model for the discrimination of MER signals belonging to the STN. APPROACH We explored the use of different sets of spike-dependent and spike-independent features in combination with an Ensemble Trees classification (ET) algorithm on a dataset composed of thirteen patients receiving bilateral DBS. We compared results from six subsets of features and two dataset conditions (with and without standardization) using performance metrics on a leave-one-patient-out validation schema. MAIN RESULTS We obtained statistically better results (i.e., higher accuracy p-value = 0.003) on the raw dataset than on the standardized one, where the selection of seven features using a minimum redundancy maximum relevance (MRMR) algorithm provided a mean accuracy of 94.1%, comparable with the use of the full set of features. In the same conditions, the spike-dependent features provided the lowest accuracy (86.8%), while a power density-based index was shown to be a good indicator of STN activity (92.3%). SIGNIFICANCE Results suggest that a small and simple set of features can be used for an efficient classification of microelectrode recordings to implement an intraoperative support for clinical decision during deep brain stimulation surgery.
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Affiliation(s)
- Stefania Coelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Lombardia, ITALY
| | - Vincenzo Levi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Lombardia, ITALY
| | | | - Enrico Mailland
- Neurology Unit, Dipartimento di Area Medica Internistica, ASST Santi Paolo e Carlo, Milano, Lombardia, ITALY
| | - Sara Rinaldo
- Movement Disorder Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Lombardia, ITALY
| | - Roberto Eleopra
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Lombardia, ITALY
| | - Anna Maria Bianchi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Lombardia, ITALY
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10
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Bos MJ, Alzate Sanchez AM, Bancone R, Temel Y, de Greef BT, Absalom AR, Gommer ED, van Kranen-Mastenbroek VH, Buhre WF, Roberts MJ, Janssen ML. Influence of Anesthesia and Clinical Variables on the Firing Rate, Coefficient of Variation and Multi-Unit Activity of the Subthalamic Nucleus in Patients with Parkinson's Disease. J Clin Med 2020; 9:jcm9041229. [PMID: 32344572 PMCID: PMC7230272 DOI: 10.3390/jcm9041229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Microelectrode recordings (MER) are used to optimize lead placement during subthalamic nucleus deep brain stimulation (STN-DBS). To obtain reliable MER, surgery is usually performed while patients are awake. Procedural sedation and analgesia (PSA) is often desirable to improve patient comfort, anxiolysis and pain relief. The effect of these agents on MER are largely unknown. The objective of this study was to determine the effects of commonly used PSA agents, dexmedetomidine, clonidine and remifentanil and patient characteristics on MER during DBS surgery. Methods: Data from 78 patients with Parkinson’s disease (PD) who underwent STN-DBS surgery were retrospectively reviewed. The procedures were performed under local anesthesia or under PSA with dexmedetomidine, clonidine or remifentanil. In total, 4082 sites with multi-unit activity (MUA) and 588 with single units were acquired. Single unit firing rates and coefficient of variation (CV), and MUA total power were compared between patient groups. Results: We observed a significant reduction in MUA, an increase of the CV and a trend for reduced firing rate by dexmedetomidine. The effect of dexmedetomidine was dose-dependent for all measures. Remifentanil had no effect on the firing rate but was associated with a significant increase in CV and a decrease in MUA. Clonidine showed no significant effect on firing rate, CV or MUA. In addition to anesthetic effects, MUA and CV were also influenced by patient-dependent variables. Conclusion: Our results showed that PSA influenced neuronal properties in the STN and the dexmedetomidine (DEX) effect was dose-dependent. In addition, patient-dependent characteristics also influenced MER.
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Affiliation(s)
- Michael J. Bos
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands;
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (A.M.A.S.); (R.B.); (Y.T.); (B.T.A.d.G.); (E.D.G.); (V.H.J.M.v.K.-M.)
- Correspondence:
| | - Ana Maria Alzate Sanchez
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (A.M.A.S.); (R.B.); (Y.T.); (B.T.A.d.G.); (E.D.G.); (V.H.J.M.v.K.-M.)
| | - Raffaella Bancone
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (A.M.A.S.); (R.B.); (Y.T.); (B.T.A.d.G.); (E.D.G.); (V.H.J.M.v.K.-M.)
| | - Yasin Temel
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (A.M.A.S.); (R.B.); (Y.T.); (B.T.A.d.G.); (E.D.G.); (V.H.J.M.v.K.-M.)
- Department of Neurosurgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Bianca T.A. de Greef
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (A.M.A.S.); (R.B.); (Y.T.); (B.T.A.d.G.); (E.D.G.); (V.H.J.M.v.K.-M.)
- Department of Neurology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Anthony R. Absalom
- Department of Anesthesiology, Groningen University, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Erik D. Gommer
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (A.M.A.S.); (R.B.); (Y.T.); (B.T.A.d.G.); (E.D.G.); (V.H.J.M.v.K.-M.)
- Department of Clinical Neurophysiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Vivianne H.J.M. van Kranen-Mastenbroek
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (A.M.A.S.); (R.B.); (Y.T.); (B.T.A.d.G.); (E.D.G.); (V.H.J.M.v.K.-M.)
- Department of Clinical Neurophysiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Wolfgang F. Buhre
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands;
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (A.M.A.S.); (R.B.); (Y.T.); (B.T.A.d.G.); (E.D.G.); (V.H.J.M.v.K.-M.)
| | - Mark J. Roberts
- Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
| | - Marcus L.F. Janssen
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (A.M.A.S.); (R.B.); (Y.T.); (B.T.A.d.G.); (E.D.G.); (V.H.J.M.v.K.-M.)
- Department of Clinical Neurophysiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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11
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Telkes I, Viswanathan A, Jimenez-Shahed J, Abosch A, Ozturk M, Gupte A, Jankovic J, Ince NF. Local field potentials of subthalamic nucleus contain electrophysiological footprints of motor subtypes of Parkinson's disease. Proc Natl Acad Sci U S A 2018; 115:E8567-E8576. [PMID: 30131429 PMCID: PMC6130371 DOI: 10.1073/pnas.1810589115] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Although motor subtypes of Parkinson's disease (PD), such as tremor dominant (TD) and postural instability and gait difficulty (PIGD), have been defined based on symptoms since the mid-1990s, no underlying neural correlates of these clinical subtypes have yet been identified. Very limited data exist regarding the electrophysiological abnormalities within the subthalamic nucleus (STN) that likely accompany the symptom severity or the phenotype of PD. Here, we show that activity in subbands of local field potentials (LFPs) recorded with multiple microelectrodes from subterritories of STN provide distinguishing neurophysiological information about the motor subtypes of PD. We studied 24 patients with PD and found distinct patterns between TD (n = 13) and PIGD (n = 11) groups in high-frequency oscillations (HFOs) and their nonlinear interactions with beta band in the superior and inferior regions of the STN. Particularly, in the superior region of STN, the power of the slow HFO (sHFO) (200-260 Hz) and the coupling of its amplitude with beta-band phase were significantly stronger in the TD group. The inferior region of STN exhibited fast HFOs (fHFOs) (260-450 Hz), which have a significantly higher center frequency in the PIGD group. The cross-frequency coupling between fHFOs and beta band in the inferior region of STN was significantly stronger in the PIGD group. Our results indicate that the spatiospectral dynamics of STN-LFPs can be used as an objective method to distinguish these two motor subtypes of PD. These observations might lead to the development of sensing and stimulation strategies targeting the subterritories of STN for the personalization of deep-brain stimulation (DBS).
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Affiliation(s)
- Ilknur Telkes
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204-5060
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030
| | - Joohi Jimenez-Shahed
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX 77030
| | - Aviva Abosch
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO 80045
| | - Musa Ozturk
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204-5060
| | - Akshay Gupte
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN 55455
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX 77030
| | - Nuri F Ince
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204-5060;
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12
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Basha D, Dostrovsky JO, Kalia SK, Hodaie M, Lozano AM, Hutchison WD. Gamma oscillations in the somatosensory thalamus of a patient with a phantom limb: case report. J Neurosurg 2017; 129:1048-1055. [PMID: 29125416 DOI: 10.3171/2017.5.jns17170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The amputation of an extremity is commonly followed by phantom sensations that are perceived to originate from the missing limb. The mechanism underlying the generation of these sensations is still not clear although the development of abnormal oscillatory bursting in thalamic neurons may be involved. The theory of thalamocortical dysrhythmia implicates gamma oscillations in phantom pathophysiology although this rhythm has not been previously observed in the phantom limb thalamus. In this study, the authors report the novel observation of widespread 38-Hz gamma oscillatory activity in spike and local field potential recordings obtained from the ventral caudal somatosensory nucleus of the thalamus (Vc) of a phantom limb patient undergoing deep brain stimulation (DBS) surgery. Interestingly, microstimulation near tonically firing cells in the Vc resulted in high-frequency, gamma oscillatory discharges coincident with phantom sensations reported by the patient. Recordings from the somatosensory thalamus of comparator groups (essential tremor and pain) did not reveal the presence of gamma oscillatory activity.
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Affiliation(s)
- Diellor Basha
- Departments of1Physiology and.,4Krembil Western Research Institute, Toronto, Ontario, Canada
| | - Jonathan O Dostrovsky
- Departments of1Physiology and.,3Division of Neurosurgery, Toronto Western Hospital; and.,4Krembil Western Research Institute, Toronto, Ontario, Canada
| | - Suneil K Kalia
- 2Surgery, University of Toronto.,4Krembil Western Research Institute, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- 2Surgery, University of Toronto.,4Krembil Western Research Institute, Toronto, Ontario, Canada
| | - Andres M Lozano
- 2Surgery, University of Toronto.,4Krembil Western Research Institute, Toronto, Ontario, Canada
| | - William D Hutchison
- Departments of1Physiology and.,3Division of Neurosurgery, Toronto Western Hospital; and.,4Krembil Western Research Institute, Toronto, Ontario, Canada
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13
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Themistocleous MS, Sakas DE, Boviatsis E, Tagaris G, Kouyialis A, Psachoulia C, Stathis P. The Insertion of Electrodes in the Brain for Electrophysiological Recording or Chronic Stimulation Is Not Associated With Any Biochemically Detectable Neuronal Injury. Neuromodulation 2017; 20:424-428. [PMID: 28393415 DOI: 10.1111/ner.12598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/29/2017] [Accepted: 02/15/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the degree of brain tissue injury that could be potentially induced by the introduction of a) microrecording electrodes, b) macrostimulation electrodes, or c) chronic stimulation electrodes. We aimed to evaluate whether the use of five simultaneous microrecording tracks is associated with any brain injury not detectable by conventional imaging such as CT or MRI. MATERIALS AND METHODS The study included 61 patients who underwent surgery for implantation of 121 DBS leads. In all cases, five simultaneous tracts were utilized for microelectrode recordings. All patients underwent measurements of serum S-100b at specific time points as follows: a) prior to the operation, and b) intraoperatively at specific stages of the procedure: 1) after opening the burr hole, 2) after the insertion of microrecording electrodes, 3) during macrostimulation, 4) at the end of the operation, and 5) on the first postoperative day. RESULTS The levels of serum S-100B protein remained within the normal range during the entire period of investigation in all patients with the exception of two cases. In both patients, the procedure was complicated by intraparenchymal hemorrhage visible in neuro-imaging. The first patient developed a small intraparenchymal hemorrhage, visible on the postoperative MRI, with no neurological deficit. The second patient experienced a focal epileptic seizure after the insertion of the right DBS chronic lead and the postoperative CT scan revealed a right frontal lobe hemorrhage. CONCLUSION These results strongly indicate that the insertion of either multiple recording electrodes or the implantation of chronic electrodes in DBS does not increase the risk of brain hemorrhage or of other intracranial complications, and furthermore it does not cause any biochemically detectable brain tissue damage.
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Affiliation(s)
- Marios S Themistocleous
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" Hospital, Athens, Greece.,P. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
| | - Damianos E Sakas
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" Hospital, Athens, Greece.,P. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
| | - Efstathios Boviatsis
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" Hospital, Athens, Greece.,P. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
| | - George Tagaris
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" Hospital, Athens, Greece.,P. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
| | - Andreas Kouyialis
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" Hospital, Athens, Greece
| | | | - Pantelis Stathis
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" Hospital, Athens, Greece.,P. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
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14
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Marmor O, Valsky D, Joshua M, Bick AS, Arkadir D, Tamir I, Bergman H, Israel Z, Eitan R. Local vs. volume conductance activity of field potentials in the human subthalamic nucleus. J Neurophysiol 2017; 117:2140-2151. [PMID: 28202569 DOI: 10.1152/jn.00756.2016] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/22/2022] Open
Abstract
Subthalamic nucleus field potentials have attracted growing research and clinical interest over the last few decades. However, it is unclear whether subthalamic field potentials represent locally generated neuronal subthreshold activity or volume conductance of the organized neuronal activity generated in the cortex. This study aimed at understanding of the physiological origin of subthalamic field potentials and determining the most accurate method for recording them. We compared different methods of recordings in the human subthalamic nucleus: spikes (300-9,000 Hz) and field potentials (3-100 Hz) recorded by monopolar micro- and macroelectrodes, as well as by differential-bipolar macroelectrodes. The recordings were done outside and inside the subthalamic nucleus during electrophysiological navigation for deep brain stimulation procedures (150 electrode trajectories) in 41 Parkinson's disease patients. We modeled the signal and estimated the contribution of nearby/independent vs. remote/common activity in each recording configuration and area. Monopolar micro- and macroelectrode recordings detect field potentials that are considerably affected by common (probably cortical) activity. However, bipolar macroelectrode recordings inside the subthalamic nucleus can detect locally generated potentials. These results are confirmed by high correspondence between the model predictions and actual correlation of neuronal activity recorded by electrode pairs. Differential bipolar macroelectrode subthalamic field potentials can overcome volume conductance effects and reflect locally generated neuronal activity. Bipolar macroelectrode local field potential recordings might be used as a biological marker of normal and pathological brain functions for future electrophysiological studies and navigation systems as well as for closed-loop deep brain stimulation paradigms.NEW & NOTEWORTHY Our results integrate a new method for human subthalamic recordings with a development of an advanced mathematical model. We found that while monopolar microelectrode and macroelectrode recordings detect field potentials that are considerably affected by common (probably cortical) activity, bipolar macroelectrode recordings inside the subthalamic nucleus (STN) detect locally generated potentials that are significantly different than those recorded outside the STN. Differential bipolar subthalamic field potentials can be used in navigation and closed-loop deep brain stimulation paradigms.
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Affiliation(s)
- Odeya Marmor
- Department of Medical Neurobiology (Physiology), Institute of Medical Research, Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Dan Valsky
- Department of Medical Neurobiology (Physiology), Institute of Medical Research, Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research, the Hebrew University, Jerusalem, Israel
| | - Mati Joshua
- Department of Medical Neurobiology (Physiology), Institute of Medical Research, Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research, the Hebrew University, Jerusalem, Israel
| | - Atira S Bick
- Department of Medical Neurobiology (Physiology), Institute of Medical Research, Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Arkadir
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Idit Tamir
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,The Center for Functional and Restorative Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and
| | - Hagai Bergman
- Department of Medical Neurobiology (Physiology), Institute of Medical Research, Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research, the Hebrew University, Jerusalem, Israel
| | - Zvi Israel
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,The Center for Functional and Restorative Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and
| | - Renana Eitan
- Department of Medical Neurobiology (Physiology), Institute of Medical Research, Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel; .,The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Functional Neuroimaging Laboratory, Brigham and Women's Hospital, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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15
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Telkes I, Jimenez-Shahed J, Viswanathan A, Abosch A, Ince NF. Prediction of STN-DBS Electrode Implantation Track in Parkinson's Disease by Using Local Field Potentials. Front Neurosci 2016; 10:198. [PMID: 27242404 PMCID: PMC4860394 DOI: 10.3389/fnins.2016.00198] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/21/2016] [Indexed: 12/24/2022] Open
Abstract
Optimal electrophysiological placement of the DBS electrode may lead to better long term clinical outcomes. Inter-subject anatomical variability and limitations in stereotaxic neuroimaging increase the complexity of physiological mapping performed in the operating room. Microelectrode single unit neuronal recording remains the most common intraoperative mapping technique, but requires significant expertise and is fraught by potential technical difficulties including robust measurement of the signal. In contrast, local field potentials (LFPs), owing to their oscillatory and robust nature and being more correlated with the disease symptoms, can overcome these technical issues. Therefore, we hypothesized that multiple spectral features extracted from microelectrode-recorded LFPs could be used to automate the identification of the optimal track and the STN localization. In this regard, we recorded LFPs from microelectrodes in three tracks from 22 patients during DBS electrode implantation surgery at different depths and aimed to predict the track selected by the neurosurgeon based on the interpretation of single unit recordings. A least mean square (LMS) algorithm was used to de-correlate LFPs in each track, in order to remove common activity between channels and increase their spatial specificity. Subband power in the beta band (11–32 Hz) and high frequency range (200–450 Hz) were extracted from the de-correlated LFP data and used as features. A linear discriminant analysis (LDA) method was applied both for the localization of the dorsal border of STN and the prediction of the optimal track. By fusing the information from these low and high frequency bands, the dorsal border of STN was localized with a root mean square (RMS) error of 1.22 mm. The prediction accuracy for the optimal track was 80%. Individual beta band (11–32 Hz) and the range of high frequency oscillations (200–450 Hz) provided prediction accuracies of 72 and 68% respectively. The best prediction result obtained with monopolar LFP data was 68%. These results establish the initial evidence that LFPs can be strategically fused with computational intelligence in the operating room for STN localization and the selection of the track for chronic DBS electrode implantation.
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Affiliation(s)
- Ilknur Telkes
- Clinical Neural Engineering Lab., Biomedical Engineering Department, University of Houston Houston, TX, USA
| | | | | | - Aviva Abosch
- Department of Neurosurgery, University of Colorado Aurora, CO, USA
| | - Nuri F Ince
- Clinical Neural Engineering Lab., Biomedical Engineering Department, University of Houston Houston, TX, USA
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16
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Feng H, Zhuang P, Hallett M, Zhang Y, Li J, Li Y. Characteristics of subthalamic oscillatory activity in parkinsonian akinetic-rigid type and mixed type. Int J Neurosci 2015; 126:819-828. [PMID: 26268485 DOI: 10.3109/00207454.2015.1074225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To explore neurons with β oscillatory activity in the subthalamic nucleus (STN) in relation to parkinsonian motor signs. METHODS We studied 27 patients with Parkinson's disease (PD) who underwent electrode implantation for STN deep brain stimulation. Thirteen patients were classified as akinetic-rigid (AR) type and 14 patients were classified as mixed type. Microelectrode recording was performed in the STN and the electromyogram (EMG) was simultaneously recorded. Single-unit and spectral analyses were performed. Coherence analysis was used to explore the relationship between β oscillatory activity and EMG activity. Unpaired t-test and chi-square were used to compare the differences between the two PD types. RESULTS Of 130 neurons identified in the AR type, 43.8% were β oscillatory neurons (mean: 21.3 ± 6.87 Hz, βFB) and 0.8% were tremor frequency oscillatory neurons (4-6 Hz, TFB). Of 102 neurons identified in the mixed type, 19.6% were β oscillatory neurons and 26.5% were TFB oscillatory neurons. There was a significant difference in proportion of neurons with βFB and TFB oscillations between the two PD groups. Additionally, 12% of the βFB oscillatory neurons were coherent with limb EMG of the AR type, but there was no coherence in the mixed type. Most oscillatory neurons were localized in the dorsal portion of the STN. CONCLUSION The STN βFB oscillatory neurons correlate with parkinsonian rigidity-bradykinesia. The high proportion of βFB oscillatory neurons found in the AR type of PD is indirect evidence for their importance in generating motor impairment.
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Affiliation(s)
- Huanhuan Feng
- a 1 Beijing Institute of Functional Neurosurgery, Xuanwu Hospital , Capital Medical University , Beijing , China.,b 2 Center of Parkinson's Disease , Beijing Institute for Brain Disorders , Beijing , China.,c 3 Key Laboratory of Neurodegenerative Diseases (Capital Medical University) , Ministry of Education , Beijing , China
| | - Ping Zhuang
- a 1 Beijing Institute of Functional Neurosurgery, Xuanwu Hospital , Capital Medical University , Beijing , China.,b 2 Center of Parkinson's Disease , Beijing Institute for Brain Disorders , Beijing , China.,c 3 Key Laboratory of Neurodegenerative Diseases (Capital Medical University) , Ministry of Education , Beijing , China
| | - Mark Hallett
- d 4 Human Motor Control Section, Medical Neurology Branch , National Institute of Neurological Disorders and Stroke, NIH , Bethesda , MD , USA
| | - Yuqing Zhang
- a 1 Beijing Institute of Functional Neurosurgery, Xuanwu Hospital , Capital Medical University , Beijing , China.,b 2 Center of Parkinson's Disease , Beijing Institute for Brain Disorders , Beijing , China.,c 3 Key Laboratory of Neurodegenerative Diseases (Capital Medical University) , Ministry of Education , Beijing , China
| | - Jianyu Li
- a 1 Beijing Institute of Functional Neurosurgery, Xuanwu Hospital , Capital Medical University , Beijing , China.,b 2 Center of Parkinson's Disease , Beijing Institute for Brain Disorders , Beijing , China.,c 3 Key Laboratory of Neurodegenerative Diseases (Capital Medical University) , Ministry of Education , Beijing , China
| | - Yongjie Li
- a 1 Beijing Institute of Functional Neurosurgery, Xuanwu Hospital , Capital Medical University , Beijing , China.,b 2 Center of Parkinson's Disease , Beijing Institute for Brain Disorders , Beijing , China.,c 3 Key Laboratory of Neurodegenerative Diseases (Capital Medical University) , Ministry of Education , Beijing , China
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Alvarado-Rojas C, Lehongre K, Bagdasaryan J, Bragin A, Staba R, Engel J, Navarro V, Le Van Quyen M. Single-unit activities during epileptic discharges in the human hippocampal formation. Front Comput Neurosci 2013; 7:140. [PMID: 24151464 PMCID: PMC3799238 DOI: 10.3389/fncom.2013.00140] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/27/2013] [Indexed: 11/13/2022] Open
Abstract
Between seizures the brain of patients with epilepsy generates pathological patterns of synchronous activity, designated as interictal epileptiform discharges (ID). Using microelectrodes in the hippocampal formations of 8 patients with drug-resistant temporal lobe epilepsy, we studied ID by simultaneously analyzing action potentials from individual neurons and the local field potentials (LFPs) generated by the surrounding neuronal network. We found that ~30% of the units increased their firing rate during ID and 40% showed a decrease during the post-ID period. Surprisingly, 30% of units showed either an increase or decrease in firing rates several hundred of milliseconds before the ID. In 4 patients, this pre-ID neuronal firing was correlated with field high-frequency oscillations at 40-120 Hz. Finally, we observed that only a very small subset of cells showed significant coincident firing before or during ID. Taken together, we suggested that, in contrast to traditional views, ID are generated by a sparse neuronal network and followed a heterogeneous synchronization process initiated over several hundreds of milliseconds before the paroxysmal discharges.
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Affiliation(s)
- Catalina Alvarado-Rojas
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière, INSERM UMRS 975 - CNRS UMR 7225, Hôpital de la Pitié-SalpêtrièreParis, France
- Université Pierre et Marie CurieParis, France
| | - Katia Lehongre
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière, INSERM UMRS 975 - CNRS UMR 7225, Hôpital de la Pitié-SalpêtrièreParis, France
- Université Pierre et Marie CurieParis, France
| | - Juliana Bagdasaryan
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière, INSERM UMRS 975 - CNRS UMR 7225, Hôpital de la Pitié-SalpêtrièreParis, France
- Université Pierre et Marie CurieParis, France
| | - Anatol Bragin
- Department of Neurology, David Geffen School of Medicine at UCLALos Angeles, CA, USA
| | - Richard Staba
- Department of Neurology, David Geffen School of Medicine at UCLALos Angeles, CA, USA
| | - Jerome Engel
- Department of Neurology, David Geffen School of Medicine at UCLALos Angeles, CA, USA
| | - Vincent Navarro
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière, INSERM UMRS 975 - CNRS UMR 7225, Hôpital de la Pitié-SalpêtrièreParis, France
- Université Pierre et Marie CurieParis, France
- Epilepsy Unit, Groupe Hospitalier Pitié-SalpêtrièreParis, France
| | - Michel Le Van Quyen
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière, INSERM UMRS 975 - CNRS UMR 7225, Hôpital de la Pitié-SalpêtrièreParis, France
- Université Pierre et Marie CurieParis, France
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