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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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