Dorsolateral subthalamic neuronal activity enhanced by median nerve stimulation characterizes Parkinson’s disease during deep brain stimulation with general anesthesia

Abstract

S ubthalamic nucleus (STN) deep brain stimulation (DBS) has been shown to be an effective treatment for advanced Parkinson's disease (PD) and yields good long-term motor outcome. 25 Conventionally, STN-DBS is a surgical procedure conducted while the patient receives a local anesthetic and remains awake to ensure accurate electrophysiological mapping. In addition, this approach allows physicians to conduct intraoperative macrostimulation tests for motor response while minimizing potential side effects of stimulation. However, if a patient with PD is experiencing drastic off-medication symptoms, such as anxiety, painful dystonia, and respiratory distress, the patient may be precluded from this lengthy surgical procedure. 16,26 We previously reported our long-term results describing patients with PD who underwent STN-DBS under conditioned general anesthe- (PD). However, few studies are available that report whether neuronal firing can be accurately recorded during this condition. In this study the authors attempted to characterize the neuronal activity of the subthalamic nucleus (STN) and elucidate the influence of general anesthetics on neurons during DBS surgery in patients with PD. The benefit of median nerve stimulation (MNS) for localization of the dorsolateral subterritory of the STN, which is involved in sensorimotor function, was explored. methods Eight patients with PD were anesthetized with desflurane and underwent contralateral MNS at the wrist during microelectrode recording of the STN. The authors analyzed the spiking patterns and power spectral density (PSD) of the background activity along each penetration track and determined the spatial correlation to the target location, estimated using standard neurophysiological procedures. results The dorsolateral STN spiking pattern showed a more prominent bursting pattern without MNS and more oscillation with MNS. In terms of the neural oscillation of the background activity, beta-band oscillation dominated within the sensorimotor STN and showed significantly more PSD during MNS (p < 0.05). coNclusioNs Neuronal firing within the STN could be accurately identified and differentiated when patients with PD received general anesthetics. Median nerve stimulation can enhance the neural activity in beta-band oscillations, which can be used as an index to ensure optimal electrode placement via successfully tracked dorsolateral STN topography.

Intraoperative Localization of the Subthalamic Nucleus Using Long-Latency Somatosensory Evoked Potentials

“…We found specific patterns of neuronal firing activity as registered by trajectories within the STN, which is in agreement with previous studies documenting that neuronal firing patterns within the STN could be accurately identified and differentiated in PD patients even under effect of general anesthesia .…”

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

“…Previously, we reported that STN neuronal signals could be identified under light desflurane GA, and the long-term effect was comparable to that of LA (Lin et al, 2008 ). We also reported that contralateral median nerve stimulation during recording could enhance the signals (Tsai et al, 2015 ). However, inhalation anesthetics can still affect the microelectrode signals and possibly hinder their performance during DBS surgery (Sanghera et al, 2003 ).…”

“…The prominent spike firing patterns found in STN MERs reportedly include tonic irregular single-spike activity, burst-firing activity, and neuronal oscillations with non-stationary properties (Favre et al, 1999 ; Bingmer et al, 2011 ; Tsai et al, 2015 ). To distinguish these firing patterns in response to GA or LA, power spectral analyses of autocorrelograms were separately calculated from the spike trains during the burst periods and the regularly-spiking periods.…”

Early versus Late Application of Subthalamic deep brain Stimulation to Parkinson’s disease patients with motor complications (ELASS): protocol of a multicentre, prospective and observational study

“…In cases where general anaesthesia is used, somatosensory evoked potentials elicited by median nerve stimulation will be used to facilitate localisation of the STN. 26 Test stimulations will be applied to patients under local anaesthesia to monitor improvements of parkinsonian signs and stimulation-induced side effects. (3) Leads will be secured at the burr hole site using the Stimloc system (Medtronic, Minneapolis, Minnesota, USA).…”