Neuropsychological Effects After Chronic Subthalamic Stimulation and the Topography of the Nucleus in Parkinson's Disease

Tsai, Sheng-Tzung; Lin, Sheng Huang; Lin, Shinn Zong; Chen, Jen Yeu; Lee, Chi Wei; Chen, Shin-Yuan

doi:10.1227/01.neu.0000303198.95296.6f

Cited by 63 publications

(61 citation statements)

References 51 publications

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“…1,19 In accordance with clinical observations, high-frequency DBS within this region has also been demonstrated to achieve the best motor outcome for patients with PD and avoids the neuropsychological side effects due to current diffusion. 24 Our findings demonstrate significant bursty firing and synchronization of oscillatory cells within the dorsolateral STN, which are similar to those of previous studies. Seifried et al's study not only showed the characteristic firing types of STN cells but also highlighted the importance of various percentages of firing patterns on the delineation of STN topography.…”

Section: Discussionsupporting

confidence: 92%

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

Tsai¹,

Chuang

Kuo

et al. 2015

JNS

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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.

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Section: Discussionsupporting

confidence: 92%

“…24 An acute stimulation test was performed 1 week after surgery to select the optimal stimulation contact and parameters for chronic stimulation.…”

Section: Localization Of Active Contact With Postoperative Ctmentioning

confidence: 99%

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

Tsai¹,

Chuang

Kuo

et al. 2015

JNS

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“…In our study, we did not perform test stimulation, but no patient suffered post-operative capsular effects because our selection criteria for the trajectory of electrode implantation chose the most appropriate track [54]. The knowledge of STN topography is crucial in general anesthesia DBS surgery; therefore, MER must be used as it is the only intra-operative tool to identify the STN, map its boundaries, and map its sensorimotor component through the detection of movementrelated neuronal firing [61,[63][64][65].…”

Section: General Anesthetic Dbs Proceduresmentioning

confidence: 99%

Controversial Issues in Deep Brain Stimulation in Parkinson's Disease

Chen¹,

Tsai²,

Lin³

2011

Towards New Therapies for Parkinson's Disease

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“…3 A high level of accuracy is required as the motor region of the STN is posterolateral, and unwanted stimulation side effects may occur as a result of direct stimulation or spread to the anteromedial nonmotor area and the adjacent corticospinal tract. 9,18,31,56 Current imaging of STN borders is difficult.…”

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confidence: 99%

Magnetic resonance imaging of the subthalamic nucleus for deep brain stimulation

Chandran¹,

Bynevelt

Lind

2016

JNS

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F uture progress to refine targets for deep brain stimulation (DBS) is critically dependent on precise placement and verification of electrodes in the brain. No stereotactic target is of more clinical importance or more nuanced regarding its imaging than the subthalamic nucleus (STN). The STN is difficult to image because of its biconvex shape, small size, oblique spatial orientation in 3 planes, and its close proximity to the substantia nigra (SN).3 A high level of accuracy is required as the motor region of the STN is posterolateral, and unwanted stimulation side effects may occur as a result of direct stimulation or spread to the anteromedial nonmotor area and the adjacent corticospinal tract. 9,18,31,56 Current imaging of STN borders is difficult.Targeting of the STN has historically been performed indirectly; the neurosurgeon predicts the location of the STN based on coordinates derived from atlases. These coordinates have often been related to the midcommissural point, which was derived from x-ray ventriculography but also from CT and MRI. Retaining this indirect, coordinate-based approach has been attractive to neurosurgeons. Experience in using this approach has been handed down from the past and can be used even with modern noninvasive imaging, and targeting preferences can be easily communicated between surgeons. The problem with indirect targeting is that different patients have different STN sizes, shapes, and positions.38 Direct targeting is an attempt to locate the STN in each individual patient.Poor image quality on traditional 1.5 tesla (T) scanners and primitive pulse sequences that do not provide adequate contrast at the level of the STN have limited the progression of direct targeting in some centers. Also hindering the development of stereotactic MRI are concerns about image distortion with higher field strength; traditional stereotactic head frames and localizers are too bulky to permit the use of high-quality, multichannel MRI head coils.Despite these challenges, higher field strength scanners and new pulse sequences have improved image quality to a point that some groups have adopted direct targeting of the STN, based on MRI.3,9,37 Difficulty delineating the STN and spatial inaccuracy has resulted in reluctance from others to abandon adjuncts such as CT/MRI merge and intraoperative electrophysiology.Traditionally, T2-weighted imaging (T2WI) has been used to plan for direct targeting of the STN using a variety of imaging parameters (Fig. 1).9 Although T2WI is useful, it is difficult to clearly delineate the STN from the SN and, to a lesser extent, the zona incerta (ZI). 22,32,37 abbreviatioNs CNR = contrast-to-noise ratio; DBS = deep brain stimulation; DTI = diffusion tensor imaging; FA = fractional anisotropy; FGATIR = fast gray matter acquisition T1 IR; FLAIR = fluid attenuated IR; FLASH = fast low-angle shot; FSE = fast spin echo; GRE = gradient echo; IR = inversion recovery; NSA = number of signal averages; PSIR = phase-sensitive IR; QSM = quantitative susceptibility mapping; SE = spin ...

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Neuropsychological Effects After Chronic Subthalamic Stimulation and the Topography of the Nucleus in Parkinson's Disease

Cited by 63 publications

References 51 publications

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

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

Controversial Issues in Deep Brain Stimulation in Parkinson's Disease

Magnetic resonance imaging of the subthalamic nucleus for deep brain stimulation

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