Toward asleep DBS: cortico-basal ganglia spectral and coherence activity during interleaved propofol/ketamine sedation mimics NREM/REM sleep activity

Baker, Halen; Nizri, Orilia Ben-Yishay; Firman, Shimon; Werner-Reiss, Uri; Kapuller, V.М.; Israel, Zvi; Bergman, Hagai

doi:10.1038/s41531-021-00211-9

Cited by 12 publications

(24 citation statements)

References 66 publications

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“…To enable DBS under sedation, asleep DBS, we characterized the cortico-basal ganglia neuronal network of two non-human primates under propofol, ketamine and interleaved propofolketamine (IPK) sedation (Guang et al, 2021). Further, we compared these sedation states in the healthy and Parkinsonian condition to those of healthy sleep.…”

Section: Optimizing the Asleep Deep Brain Stimulation Surgical Proced...mentioning

confidence: 99%

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Proceedings of the Ninth Annual Deep Brain Stimulation Think Tank: Advances in Cutting Edge Technologies, Artificial Intelligence, Neuromodulation, Neuroethics, Pain, Interventional Psychiatry, Epilepsy, and Traumatic Brain Injury

Wong

Deuschl

Wolke

et al. 2022

Front. Hum. Neurosci.

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DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers (from industry and academia) can freely discuss current and emerging deep brain stimulation (DBS) technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury.

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Section: Optimizing the Asleep Deep Brain Stimulation Surgical Proced...mentioning

confidence: 99%

“…This is particularly relevant when considering electrophysiological data in tremor patients, (right, wake-upper, green; NREM-center, blue; and REM-lower, red). Modified with permission from Guang et-al 2021 (Guang et al, 2021).…”

Section: Fusing Electrophysiology and Neuroimaging For Optimal Deep B...mentioning

confidence: 99%

Proceedings of the Ninth Annual Deep Brain Stimulation Think Tank: Advances in Cutting Edge Technologies, Artificial Intelligence, Neuromodulation, Neuroethics, Pain, Interventional Psychiatry, Epilepsy, and Traumatic Brain Injury

Wong

Deuschl

Wolke

et al. 2022

Front. Hum. Neurosci.

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“…Recent animal studies imply that low dose ketamine can be used during MER of the basal ganglia and cortex, without disrupting electrophysiological activity used for DBS navigation 27 .…”

Section: (Which Was Not Certified By Peer Review) Preprintmentioning

confidence: 99%

“…Ketamine has been reported to attenuate post-operative cognitive dysfunction, improve postoperative analgesia and reduce inflammatory responses during surgery 22,35,37 . In contrast to classic sedatives like GABA-receptors agonists, ketamine is a dissociative drug that does not suppress cardio-pulmonary homeostatic reflexes and does not mask brain electrophysiological activity 27 .…”

Section: The Use Of Ketamine In Neurosurgerymentioning

confidence: 99%

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Ketamine Sedation Facilitates Asleep DBS: a multicenter retrospective study

Erdman

Kornilov

Kahana

et al. 2021

Preprint

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Deep brain stimulation (DBS) is commonly and safely performed for selective Parkinson's disease patients. Many centers perform DBS lead positioning exclusively under local anesthesia, to allow for brain microelectrode recordings (MER) and testing of stimulation-related therapeutic and side effects. These measures enable physiological identification of the DBS targets based on electrophysiological properties like firing rates and patterns, optimization of lead placement accuracy, and intra-operative evaluation of therapeutic window. Nevertheless, due to the challenges of awake surgery, some centers use sedation or general anesthesia, despite the distortion of discharge properties, and potential impact on clinical outcomes. Thus, there is a need for a novel anesthesia regimen that enables sedation without compromising intra-operative monitoring. This study investigates the use of low-dose ketamine for conscious sedation during lead positioning in subthalamic nucleus (STN) DBS for Parkinson's disease patients. Three anesthetic regimens were retrospectively compared in 38 surgeries across three DBS centers: 1) Interleaved propofol-ketamine (PK), 2) Interleaved propofol-awake (PA), and 3) Fully awake (AA). All anesthesia regimens achieved satisfactory MER. Automatic detection of STN borders and subdomains using a Hidden Markov Model was similar between the groups. Patients' symptoms and cooperation during stimulation testing in the ketamine group was not altered. No major adverse effects were reported in the different anesthesia protocols. These results support the use of low-dose ketamine as a novel alternative for the existing DBS anesthesia regimens, optimizing patient's experience while preserving lead placement accuracy. A prospective study should be performed to confirm these findings.

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Interleaved Propofol‐Ketamine Maintains DBS Physiology and Hemodynamic Stability: A Double‐Blind Randomized Controlled Trial

Kornilov,

Baker Erdman,

Kahana

et al. 2024

Movement Disorders

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BackgroundThe gold standard anesthesia for deep brain stimulation (DBS) surgery is the “awake” approach, using local anesthesia alone. Although it offers high‐quality microelectrode recordings and therapeutic‐window assessment, it potentially causes patients extreme stress and might result in suboptimal surgical outcomes. General anesthesia or deep sedation is an alternative, but may reduce physiological testing reliability and lead localization accuracy.ObjectivesThe aim is to investigate a novel anesthesia regimen of ketamine‐induced conscious sedation for the physiological testing phase of DBS surgery.MethodsParkinson's patients undergoing subthalamic DBS surgery were randomly divided into experimental and control groups. During physiological testing, the groups received 0.25 mg/kg/h ketamine infusion and normal saline, respectively. Both groups had moderate propofol sedation before and after physiological testing. The primary outcome was recording quality. Secondary outcomes included hemodynamic stability, lead accuracy, motor and cognitive outcome, patient satisfaction, and adverse events.ResultsThirty patients, 15 from each group, were included. Intraoperatively, the electrophysiological signature and lead localization were similar under ketamine and saline. Tremor amplitude was slightly lower under ketamine. Postoperatively, patients in the ketamine group reported significantly higher satisfaction with anesthesia. The improvement in Unified Parkinson's disease rating scale part‐III was similar between the groups. No negative effects of ketamine on hemodynamic stability or cognition were reported perioperatively.ConclusionsKetamine‐induced conscious sedation provided high quality microelectrode recordings comparable with awake conditions. Additionally, it seems to allow superior patient satisfaction and hemodynamic stability, while maintaining similar post‐operative outcomes. Therefore, it holds promise as a novel alternative anesthetic regimen for DBS. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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Toward asleep DBS: cortico-basal ganglia spectral and coherence activity during interleaved propofol/ketamine sedation mimics NREM/REM sleep activity

Cited by 12 publications

References 66 publications

Proceedings of the Ninth Annual Deep Brain Stimulation Think Tank: Advances in Cutting Edge Technologies, Artificial Intelligence, Neuromodulation, Neuroethics, Pain, Interventional Psychiatry, Epilepsy, and Traumatic Brain Injury

Proceedings of the Ninth Annual Deep Brain Stimulation Think Tank: Advances in Cutting Edge Technologies, Artificial Intelligence, Neuromodulation, Neuroethics, Pain, Interventional Psychiatry, Epilepsy, and Traumatic Brain Injury

Ketamine Sedation Facilitates Asleep DBS: a multicenter retrospective study

Interleaved Propofol‐Ketamine Maintains DBS Physiology and Hemodynamic Stability: A Double‐Blind Randomized Controlled Trial

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