Asleep DBS under ketamine sedation: Proof of concept

Erdman, Halen Baker; Kornilov, Evgeniya; Kahana, Eilat; Zarchi, Omer; Reiner, Johnathan; Socher, Achinoam; Strauss, Ido; Firman, Shimon; Israel, Zvi; Bergman, Hagai; Tamir, I

doi:10.1016/j.nbd.2022.105747

Cited by 9 publications

(13 citation statements)

References 46 publications

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“…27 Our study favors ketamine over awake DBS, aligning with our prior non-human primate and retrospective human studies. 14,15 Besides our work, we found only one more study reporting the benefits of ketamine in DBS. 28 However, it differs in that they used general anesthesia, a combination with remifentanil and S-ketamine instead of racemic ketamine.…”

Section: Asleep or Not Asleep?mentioning

confidence: 90%

“…We recently published a novel protocol for a well-known drug-ketamine-to create conscious dissociative sedation and enable MER and clinical assessment. 14,15 In a study on non-human primates, we demonstrated the ability to record spiking activity in the basal ganglia and the frontal cortex under ketamine sedation, with similar quality to awake recordings. Subsequently, we applied a comparable ketamine-based anesthesia protocol in humans and retrospectively showed the feasibility of recording spiking activity under ketamine during DBS surgery.…”

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confidence: 92%

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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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Section: Asleep or Not Asleep?mentioning

confidence: 90%

mentioning

confidence: 92%

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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“…The recorded STN length was extracted for each patient, and the length was normalized to an STN length of 1. 15 A segment before STN entrance equal to half of the length of the individual STN is included in the analysis as normalized distance À0.5 to 0. Beta band data were extracted using a four-pole band-pass filter from 13 to 30 Hz.…”

Section: Surgical Procedures and Intraoperative Electrode Recordingmentioning

confidence: 99%

“…A distinctive electrophysiological activity is usually demonstrated in the subthalamic nuclei (STNs) of patients with PD. 3,4 This electrophysiological signature includes oscillatory activity in the β range (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) localized to the dorsolateral STN (dorsolateral oscillatory region [DLOR], probably the STN motor domain). Increased β oscillatory activity reflects clinical OFF, and the DLOR, where such an activity is recorded, is the optimal target for deep brain stimulation (DBS).…”

Section: Introductionmentioning

confidence: 99%

The Genetic Etiology of Parkinson's Disease Does Not Robustly Affect Subthalamic Physiology

et al. 2023

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Background: It is unknown whether Parkinson's disease (PD) genetic heterogeneity, leading to phenotypic and pathological variability, is also associated with variability in the unique PD electrophysiological signature. Such variability might have practical implications for adaptive deep brain stimulation (DBS). Objective: The aim of our work was to study the electrophysiological activity in the subthalamic nucleus (STN) of patients with PD with pathogenic variants in different disease-causing genes. Methods: Electrophysiological data from participants with negative genetic tests were compared with those from GBA, LRRK2, and PRKN-PD. Results: We analyzed data from 93 STN trajectories (GBA-PD: 28, LRRK2-PD: 22, PARK-PD: 10, idiopathic PD: 33) of 52 individuals who underwent DBS surgery. Characteristics of β oscillatory activity in the dorsolateral motor part of the STN were similar for patients

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“…In the majority of the patients, surgery was performed while the patient was awake but, in those patients with severe dystonic fixed postures or those unable to tolerate an awake surgical procedure we performed surgery under general anaesthesia with a ketamine-based anaesthetic protocol. This anaesthetic protocol did not alter the electrophysiologic basal ganglia activity, allowing MER to be achievable and reliable during DBS surgery [35][36][37].…”

Section: Surgerymentioning

confidence: 99%

Mapping the electrophysiological structure of dystonic Globus Pallidus pars interna through intraoperative microelectrode recordings

Kaymak

Vissani

Rinaldo

et al. 2022

Preprint

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Objective. The Globus Pallidus pars interna (GPi) is one of the main targets for Deep Brain Stimulation (DBS) therapies for dystonia and other movement disorders. Still, a complete picture of the spiking dynamics of the nucleus is far from being achieved. Microelectrode recordings (MER) provide a unique brain window opportunity to shed light on GPi organization, which might support intraoperative DBS target localization, as previously done for the Subthalamic nucleus (STN). Approach. Here we propose a novel procedure to analyze explorative MERs from DBS implants in dystonic patients. The procedure identifies the neural activity markers discriminating neurons in the GPi from those in the neighbouring structures, as well as the markers discriminating neurons located in different regions within the GPi. Main results. The identification of the borders of the GPi based on neural markers was a difficult task, due to internal inhomogeneities in GPi firing dynamics. However, the procedure was able to exploit these inhomogeneities to characterize the internal electrophysiological structure of the GPi. In particular, we found a reliable dorsolateral gradient in firing activity and regularity. Significance. Overall, we characterized the spatial distribution of neural activity markers in the dystonic GPi, paving the way for the use of these markers for DBS target localization. The procedure we developed to achieve this result could be easily extended to MER performed for other disorders and in other areas.

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Asleep DBS under ketamine sedation: Proof of concept

Cited by 9 publications

References 46 publications

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

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

The Genetic Etiology of Parkinson's Disease Does Not Robustly Affect Subthalamic Physiology

Mapping the electrophysiological structure of dystonic Globus Pallidus pars interna through intraoperative microelectrode recordings

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