Intraoperative micro- and macrostimulation of the subthalamic nucleus in Parkinson's disease

Abstract

Studying the clinical effects induced by electrical stimulation of the subthalamic nucleus (STN) area in a parkinsonian patient under local anesthesia is a mandatory step to determine the precise location of the final chronic electrode. Using multiple microelectrodes, preferably in a concentric parallel array allows a precise mapping of the STN region. The most reliable features to determine the suitable target are stimulation-induced dyskinesias and rigidity decrease at a low intensity without adverse effects or only at far higher intensities. New skills are needed to assess all stimulation-induced effects and interpret them in anatomo-functional terms.

Distinct populations of neurons respond to emotional valence and arousal in the human subthalamic nucleus

“…DBS electrodes (model 3389; Medtronic) were implanted bilaterally under local anesthesia, guided by stereotactic magnetic resonance, microelectrode recordings (MERs), and macroelectrode intraoperative stimulation as described elsewhere (81,82). Presurgical planning was done with the SurgiPlan software system (Elekta) and was based on coregistration of preoperative frameless 3.0-T MRI using T1-weighted images (MP-RAGE sequence; 160 sagittal slices, 1.0 mm thick, with x-y resolution 1 × 1 mm; TR, 2,300 ms; TE, 4.4 ms; FA, 10 degrees) and T2-weighted images (28 axial slices and 21 coronal slices, 2 mm thick, with x-y resolution 0.9 × 0.9 mm; TR, 2,430 ms; TE, 80 ms) with preoperative frame-based 1.5-T T1-weighted images (MP-RAGE sequence; 160 sagittal slices, 1.25 mm thick, with x-y resolution 1 × 1 mm; TR, 2,500 ms; TE, 3.1 ms; FA, 45 degrees) obtained immediately before the surgical procedure with the stereotactic Leksell frame attached.…”

Modulation of Spontaneous Firing in Rat Subthalamic Neurons by 5-HT Receptor Subtypes

“…Its prominent role in the physiology and pathophysiology of the basal ganglia has been signified by the dramatic therapeutic effects of lesion or highfrequency stimulation of the STN for Parkinson's disease patients (DeLong and Wichmann 2001;Levy et al 2000;Obeso et al 2001;Pollak et al 2002).…”

Postoperative management of deep brain stimulation in Parkinson’s disease

“…Rigidity is stable and less variable than bradykinesia (which fluctuates with motivation and fatigue) and tremor (which fluctuates spontaneously depending on motor activity and psychic state). When not very pronounced, stable rigidity can be obtained using a Froment maneuver Pollak et al, 2002;Broussolle et al, 2007). Improvement in rigidity is usually associated with an improvement in the other cardinal signs in the long term, although it is not specific to the STN, and can be achieved by stimulating surrounding pallidothalamic projections.…”

“…In the operating theatre, it is not rare to observe contraversive conjugated ocular deviation induced by intraoperative microstimulation with microelectrodes correctly placed inside the STN (Pollak et al, 2002). However, during postoperative and long-term management, this side-effect rarely recurs as a clinically relevant problem (Sauleau et al, 2007).…”