Subthalamic deep brain stimulation (DBS) has rapidly become the standard surgical therapy for medically refractory Parkinson disease. However, in spite of its wide acceptance, there is considerable variability in the technical approach. This study details our technique and experience in performing microelectrode recording (MER) guided subthalamic nucleus (STN) DBS in the treatment of Parkinson disease.
Forty patients underwent surgery for the implantation of 70 STN DBS electrodes. Stereotactic localization was performed using a combination of magnetic resonance and computed tomographic imaging. We used an array of three microelectrodes, separated by 2 mm, for physiological localization of the STN. The final location was selected based on MER and macrostimulation through the DBS electrode.
The trajectory selected for the DBS electrode had an average pass through the STN of 5.6 +/- 0.4 mm on the left and 5.7 +/- 0.4 mm on the right. The predicted location was used in 42% of the cases but was modified by MER in the remaining 58%. Patients were typically discharged on the second postoperative day. Eighty-five percent of patients were sent home, 13% required short-term rehabilitation, and one patient required long-term nursing services. Seven complications occurred over 4 years. Four patients suffered small hemorrhages, one patient experienced a lead migration, one developed an infection of the pulse generator, and one patient suffered from a superficial cranial infection.
Simultaneous bilateral MER-guided subthalamic DBS is a relatively safe and well-tolerated procedure. MER plays an important role in optimal localization of the DBS electrodes.
"This has resulted in a clear reduction in operation time. Similar rates have been reported by others with atlas-based (Amirnovin et al., 2006) and MRI-based targeting coordinates (Reck et al., 2012). The change from 1.5 to 3.0 T has also improved the accuracy of targeting (Toda et al., 2009; Kerl et al., 2012). "
"Microelectrode recordings are routinely performed prior to the implantation of deep brain stimulating electrodes to aid with localization (Amirnovin et al. 2006; Gross et al. 2006). Consideration for surgery was unrelated to the research protocol and was conducted by a multidisciplinary team of neurologists, neurosurgeons, a neuropsychologist , and a nurse practitioner. "
[Show abstract][Hide abstract] ABSTRACT: We use rules to extend learned behavior beyond specific instances to general scenarios. The prefrontal cortex (PFC) is thought to play an important role in representing rules, as evidenced by subjects who have difficulty in following rules after PFC damage and by animal studies demonstrating rule sensitivity of individual PFC neurons. How rules are instantiated at the single-neuronal level in the human brain, however, remains unclear. Here, we recorded from individual neurons in the human dorsolateral prefrontal cortex (DLPFC) as subjects performed a task in which they evaluated pairs of images using either of 2 abstract rules. We find that DLPFC neurons selectively encoded these rules while carrying little information about the subjects' responses or the sensory cues used to guide their decisions.
"No sedatives were given during the surgery. The general techniques of stereotactic localization and intraoperative microelectrode recordings are described elsewhere (Hutchison et al., 1998; Amirnovin et al., 2004, 2006). We performed physiologic localization using an array of three tungsten microelectrodes (1 MOhm impedance; FHC Incorporated, Bowdoin, ME), separated by 2 mm, and placed in a parasagittal orientation. "
[Show abstract][Hide abstract] ABSTRACT: Accurately describing the spiking patterns of neurons in the subthalamic nucleus (STN) of patients suffering from Parkinson's disease (PD) is important for understanding the pathogenesis of the disease and for achieving the maximum therapeutic benefit from deep brain stimulation (DBS). We analyze the spiking activity of 24 subthalamic neurons recorded in Parkinson's patients during a directed hand movement task by using a point process generalized linear model (GLM). The model relates each neuron's spiking probability simultaneously to factors associated with movement planning and execution, directional selectivity, refractoriness, bursting, and oscillatory dynamics. The model indicated that while short-term history dependence related to refractoriness and bursting are most informative in predicting spiking activity, nearly all of the neurons analyzed have a structured pattern of long-term history dependence such that the spiking probability was reduced 20-30 ms and then increased 30-60 ms after a previous spike. This suggests that the previously described oscillatory firing of neurons in the STN of Parkinson's patients during volitional movements is composed of a structured pattern of inhibition and excitation. This point process model provides a systematic framework for characterizing the dynamics of neuronal activity in STN.
Frontiers in Integrative Neuroscience 06/2012; 6:28. DOI:10.3389/fnint.2012.00028
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