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Localization of the subthalamic nucleus in Parkinson disease using multiunit activity.

ABSTRACT: Refinement of the subthalamic nucleus (STN) coordinates using intraoperative microelectrode recordings (MER) is routinely performed during deep brain stimulation (DBS) surgeries in Parkinson disease (PD). The commonly used criteria for electrophysiological localization of the STN are qualitative. The goal of this study was to validate quantitative STN detection algorithm (QD) derived from the multi-unit activity in a prospective setting.Ten PD patients underwent STN DBS surgery. The MUA was obtained by removing large spikes close to microelectrode using wavelet method and integrating the 500-2000Hz band in the power spectral density. The qualitative intraoperative mapping of the STN using MER (IOM) versus QD was compared using Bland-Altman and Pearson's correlation analysis.The clinical efficacy was confirmed in all subjects. The mean difference between IOM and QD of the dorsal/ventral border was 0.31±0.84/0.44±0.47mm. Using Bland-Altman statistic, only 2/36 (5.6%) differences (one for the dorsal border and one for the ventral border) were out of ±2 sd line of measurement differences. Correlation between dorsal border/ventral border positions obtained by IOM and QD was 0.79, p<0.0001/0.91, p<0.0001.Both methods are in reasonable agreement and are strongly correlated. The QD gives objective coordinates of the STN borders at high precision and may be more accurate than IOM. Prospective blinded comparative studies where the DBS leads will be placed using either QD or IOM are warranted.

SUBMITTER: Novak P

PROVIDER: S-EPMC3195940 | biostudies-literature | 2011 Nov

REPOSITORIES: biostudies-literature

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Localization of the subthalamic nucleus in Parkinson disease using multiunit activity.

Novak Peter P Przybyszewski Andrzej W AW Barborica Andrei A Ravin Paula P Margolin Lee L Pilitsis Julie G JG

Journal of the neurological sciences 20111101 1-2

<h4>Background</h4>Refinement of the subthalamic nucleus (STN) coordinates using intraoperative microelectrode recordings (MER) is routinely performed during deep brain stimulation (DBS) surgeries in Parkinson disease (PD). The commonly used criteria for electrophysiological localization of the STN are qualitative. The goal of this study was to validate quantitative STN detection algorithm (QD) derived from the multi-unit activity in a prospective setting.<h4>Methods</h4>Ten PD patients underwen ...[more]

PMID: 21855895

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Project description:ObjectiveTo investigate hemispheric effects of directional versus ring subthalamic nucleus (STN) deep brain stimulation (DBS) surgery on cognitive function in patients with advanced Parkinson's disease (PD).MethodsWe examined 31 PD patients (Left STN n = 17; Right STN n = 14) who underwent unilateral subthalamic nucleus (STN) DBS as part of a NIH-sponsored randomized, cross-over, double-blind (ring vs directional) clinical trial. Outcome measures were tests of verbal fluency, auditory-verbal memory, and response inhibition. First, all participants were pooled together to study the effects of directional versus ring stimulation. Then, we stratified the groups by surgery hemisphere and studied the longitudinal changes in cognition post-unilateral STN DBS.ResultsRelative to pre-DBS cognitive baseline performances, there were no group changes in cognition following unilateral DBS for either directional or ring stimulation. However, assessment of unilateral DBS by hemisphere revealed a different pattern. The left STN DBS group had lower verbal fluency than the right STN group (t(20.66 = -2.50, p = 0.02). Over a period of eight months post-DBS, verbal fluency declined in the left STN DBS group (p = 0.013) and improved in the right STN DBS group over time (p < .001). Similarly, response inhibition improved following right STN DBS (p = 0.031). Immediate recall did not significantly differ over time, nor was it affected by implant hemisphere, but delayed recall equivalently declined over time for both left and right STN DBS groups (left STN DBS p = 0.001, right STN DBS differ from left STN DBS p = 0.794).ConclusionsDirectional and ring DBS did not differentially or adversely affect cognition over time. Regarding hemisphere effects, verbal fluency decline was observed in those who received left STN DBS, along with the left and right STN DBS declines in delayed memory. The left STN DBS verbal fluency decrement is consistent with prior bilateral DBS research, likely reflecting disruption of the basal-ganglia-thalamocortical network connecting STN and inferior frontal gyrus. Interestingly, we found an improvement in verbal fluency and response inhibition following right STN DBS. It is possible that unilateral STN DBS, particularly in the right hemisphere, may mitigate cognitive decline.

Project description:Local field potential recordings made from the basal ganglia of patients undergoing deep brain stimulation have suggested that frequency specific activity is involved in determining the rate of force development and the peak force at the outset of a movement. However, the extent to which the basal ganglia might be involved in motor performance later on in a sustained contraction is less clear. We therefore recorded from the subthalamic nucleus region (STNr) in patients with Parkinson's disease (PD) as they made maximal voluntary grips. Relative to age-matched controls they had more rapid force decrement when contraction was meant to be sustained and prolonged release reaction time and slower rate of force offset when they were supposed to release the grip. These impairments were independent from medication status. Increased STNr power over 5-12 Hz (in the theta/alpha band) independently predicted better performance-reduced force decrement, shortened release reaction time and faster rate of force offset. In contrast, lower mean levels and progressive reduction of STNr power over 55-375 Hz (high gamma/high frequency) over the period when contraction was meant to be sustained were both strongly associated with greater force decrement over time. Higher power over 13-23 Hz (low beta) was associated with more rapid force decrement during the period when grip should have been sustained, and with a paradoxical shortening of the release reaction time. These observations suggest that STNr activities at 5-12 Hz and 55-375 Hz are necessary for optimal grip performance and that deficiencies of such activities lead to motor impairments. In contrast, increased levels of 13-25 Hz activity both promote force decrement and shorten the release reaction time, consistent with a role in antagonising (and terminating) voluntary movement. Frequency specific oscillatory activities in the STNr impact on motor performance from the beginning to the end of a voluntary grip.

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Localization of the subthalamic nucleus in Parkinson disease using multiunit activity.

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Localization of the subthalamic nucleus in Parkinson disease using multiunit activity.

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