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

Trenado, Carlos; Elben, Saskia; Friggemann, Lena; Groiss, Stefan Jun; Vesper, Jan; Schnitzler, Alfons; Wojtecki, Lars

doi:10.1111/ner.12727

Cited by 5 publications

(3 citation statements)

References 19 publications

(19 reference statements)

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“…These responses are suppressed by the ablation or cooling of the somato-sensory cortex [ 20 ]. Subthalamic somato-sensory responses were later confirmed in patients with Parkinson’s disease in whom somato-sensory evoked potentials were recorded from the STN through DBS electrodes [ 23 , 24 ] and were used to optimize the localization of these electrodes within the STN [ 25 ]. Neurons in the STN have also been reported to be activated by visual stimulation in an oculomotor task in non-human primates [ 21 ] and 30% (70/226) of STN cells recorded in freely moving rats exhibit short-latency/short duration auditory responses to a tone or a white noise [ 22 ].…”

Section: Subthalamic Nucleus and Sensory Processingmentioning

confidence: 99%

The Subthalamic Nucleus: A Hub for Sensory Control via Short Three- Lateral Loop Connections with the Brainstem?

Tannir

Pautrat

Baufreton

et al. 2023

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The subthalamic nucleus (STN) is classically subdivided into sensori-motor, associative and limbic regions, which is consistent with the involvement of this structure in not only motor control, but also in cognitive and emotional tasks. However, the function of the sensory inputs to the STN’s sensori-motor territory is comparatively less well explored, although sensory responses have been reported in this structure. There is still a paucity of information regarding the characteristics of that subdivision and its potential functional role in the basal ganglia processing and more widely in associated networks. In this perspective paper, we summarize the type of sensory stimuli that have been reported to activate the STN, and describe the complex sensory properties of the STN and its anatomical link to a sensory network involving the brainstem, characterized in our recent work. Analyzing the sensory input to the STN led us to suggest the existence of previously unreported three-lateral subcortical loops between the basal ganglia and the brainstem which do not involve the cortex. Anatomically, these loops closely link the STN, the substantia nigra pars reticulata and various structures from the brainstem such as the superior colliculus and the parabrachial nucleus. We also discuss the potential role of the STN in the control of sensory activity in the brainstem and its possible contribution to favoring sensory habituation or sensitization over brainstem structures to optimize the best selection of action at a given time.

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Section: Subthalamic Nucleus and Sensory Processingmentioning

confidence: 99%

The Subthalamic Nucleus: A Hub for Sensory Control via Short Three- Lateral Loop Connections with the Brainstem?

Tannir

Pautrat

Baufreton

et al. 2023

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“…Since then, there have been several research papers about the 'early response' from the cortex to single pulses of DBS [34,35] with the extra, that even effective pallidal stimulation for Parkinson's disease, also involved the same 'fast response' and there is even a suggestion that without frontal cortical invasion, DBS is less effective [36]. Not surprisingly the EEG field evoked responses have been used as a means of identifying the effect STN site for stimulation [37].…”

Section: Gordon W Arbuthnott* and Marianela Garcia Munozmentioning

confidence: 99%

A Cortical Substrate for Parkinsonism: A Personal Journey

Arbuthnott¹,

Munoz²

2018

Int J Clin Res Trials

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“…Indeed, attempts at generating such a biomarker have been published. One example is modulation of cellular firing within the STN through median nerve stimulation [8,9]. Another example is the HaGuide Tool (Alpha Omega Engineering, Israel), which uses intraoperative MER to map the borders of the STN on the basis of beta and theta oscillations [10,11], with efforts underway to objectively identify pallidal borders [12].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative changes in the H-reflex pathway during deep brain stimulation surgery for Parkinson’s disease: A potential biomarker for optimal electrode placement

Andrews

et al. 2020

Brain Stimulation

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Background: Deep Brain Stimulation (DBS) targeting the subthalamic nucleus (STN) and globus pallidus interna (GPi) is an effective treatment for cardinal motor symptoms and motor complications in Parkinson's Disease (PD). However, malpositioned DBS electrodes can result in suboptimal therapeutic response. Objective: We explored whether recovery of the H-reflexdan easily measured electrophysiological analogue of the stretch reflex, known to be altered in PDdcould serve as an adjunct biomarker of suboptimal versus optimal electrode position during STN-or GPi-DBS implantation. Methods: Changes in soleus H-reflex recovery were investigated intraoperatively throughout awake DBS target refinement across 26 nuclei (14 STN). H-reflex recovery was evaluated during microelectrode recording (MER) and macrostimulation at multiple locations within and outside target nuclei, at varying stimulus intensities. Results: Following MER, H-reflex recovery normalized (i.e., became less Parkinsonian) in 21/26 nuclei, and correlated with on-table motor improvement consistent with an insertional effect. During macrostimulation, H-reflex recovery was maximally normalized in 23/26 nuclei when current was applied at the location within the nucleus producing optimal motor benefit. At these optimal sites, H-reflex normalization was greatest at stimulation intensities generating maximum motor benefit free of stimulation-induced side effects, with subthreshold or suprathreshold intensities generating less dramatic normalization. Conclusion: H-reflex recovery is modulated by stimulation of the STN or GPi in patients with PD and varies depending on the location and intensity of stimulation within the target nucleus. H-reflex recovery shows potential as an easily-measured, objective, patient-specific, adjunct biomarker of suboptimal versus optimal electrode position during DBS surgery for PD.

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

Cited by 5 publications

References 19 publications

The Subthalamic Nucleus: A Hub for Sensory Control via Short Three- Lateral Loop Connections with the Brainstem?

The Subthalamic Nucleus: A Hub for Sensory Control via Short Three- Lateral Loop Connections with the Brainstem?

A Cortical Substrate for Parkinsonism: A Personal Journey

Intraoperative changes in the H-reflex pathway during deep brain stimulation surgery for Parkinson’s disease: A potential biomarker for optimal electrode placement

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