Decreased Power but Preserved Bursting Features of Subthalamic Neuronal Signals in Advanced Parkinson's Patients under Controlled Desflurane Inhalation Anesthesia

Abstract

Deep brain stimulation (DBS) surgery of the subthalamic nucleus (STN) under general anesthesia (GA) had been used in Parkinson's disease (PD) patients who are unable tolerate awake surgery. The effect of anesthetics on intraoperative microelectrode recording (MER) remains unclear. Understanding the effect of anesthetics on MER is important in performing STN DBS surgery with general anesthesia. In this study, we retrospectively performed qualitive and quantitative analysis of STN MER in PD patients received STN DBS with controlled desflurane anesthesia or LA and compared their clinical outcome. From January 2005 to March 2006, 19 consecutive PD patients received bilateral STN DBS surgery in Hualien Tzu-Chi hospital under either desflurane GA (n = 10) or LA (n = 9). We used spike analysis (frequency and modified burst index [MBI]) and the Hilbert transform to obtain signal power measurements for background and spikes, and compared the characterizations of intraoperative microelectrode signals between the two groups. Additionally, STN firing pattern characteristics were determined using a combined approach based on the autocorrelogram and power spectral analysis, which was employed to investigate differences in the oscillatory activities between the groups. Clinical outcomes were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) before and after surgery. The results revealed burst firing was observed in both groups. The firing frequencies were greater in the LA group and MBI was comparable in both groups. Both the background and spikes were of significantly greater power in the LA group. The power spectra of the autocorrelograms were significantly higher in the GA group between 4 and 8 Hz. Clinical outcomes based on the UPDRS were comparable in both groups before and after DBS surgery. Under controlled light desflurane GA, burst features of the neuronal firing patterns are preserved in the STN, but power is reduced. Enhanced low-frequency (4–8 Hz) oscillations in the MERs for the GA group could be a characteristic signature of desflurane's effect on neurons in the STN.

Bilateral Subthalamic Nucleus Deep Brain Stimulation under General Anesthesia: Literature Review and Single Center Experience

“…Under desflurane inhalation, Lin et al observed that MER could be performed with a typical neuronal firing pattern and motion-related firing of STN, and the clinical results were similar in both groups [34,96].…”

Optimization of the KNN Supervised Classification Algorithm as a Support Tool for the Implantation of Deep Brain Stimulators in Patients with Parkinson’s Disease

“…In this context, a brain shift is produced when the burr holes are made [ 6 ]. The MERs signals amplitudes can vary from 50 µV up to 200 µV [ 8 , 9 , 10 ], and they are visually and acoustically analyzed, which requires a clean and crisp signal. Accordingly, signal conditioning must be done before starting the records, while using the pre-amplification module and software gain and filters in the set-up stage.…”

Propofol Anesthesia Precludes LFP-Based Functional Mapping of Pallidum during DBS Implantation

“…Although previous studies have demonstrated changes in microelectrode signals under general anesthesia [17,39], several groups have attempted using different regimens of general anesthesia under which MER can still be recorded from STN. These techniques included using less than 1% Sevoflurane concentration [45], a combination of inhalational nitrous oxide and isoflurane or intravenous propofol and remifentanil [8], desflurane inhalation [46,47] sustaining the minimal alveolar concentration below 1% during MER [48]. These findings along with our current findings emphasize importance of anesthetic dose concentration and timings on the neurophysiological recordings.…”