Motor Evoked Potentials Improve Targeting in Deep Brain Stimulation Surgery

Nikolov, Petyo; Heil, Verena; Hartmann, Christian; Ivanov, Nikola; Slotty, Philipp J.; Vesper, Jan; Schnitzler, Alfons; Groiss, Stefan Jun

doi:10.1111/ner.13386

Cited by 7 publications

(6 citation statements)

References 13 publications

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“…One of the most common side effects of STN DBS is undesirable current spread to the corticospinal tract resulting in muscle twitches and pulling, which can be measured using MEPs ( 10 – 13 ). In this study we demonstrate the threshold for eliciting an MEP response is higher when using the pulse geometries where the primary phase is anodic (i.e., CPL+ and CPF+).…”

Section: Discussionmentioning

confidence: 99%

“…Myogenic evoked potentials (MEPs) were used to evaluate the effect pulse geometry on activation of the adjacent internal capsule fibers (10)(11)(12)(13). Electromyography electrodes from Medsource Labs (Chanhassen, MN, United States) were placed on the arm contralateral to stimulation with differential recordings across the deltoids, biceps, triceps, flexor carpi radialis (FCR), and extensor digitorum communis (EDC) muscles and a ground electrode placed on the sternum.…”

Section: Data Acquisitionmentioning

confidence: 99%

“…The physiological effects of DBS in the region of the STN can be appreciated using standard electromyography (EMG) (10)(11)(12)(13)(14) and scalp electroencephalography (EEG) (15,16) based techniques. Muscle contraction represents one of the most common, amplitudelimiting side effects associated with STN DBS.…”

Section: Introductionmentioning

confidence: 99%

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Myogenic and cortical evoked potentials vary as a function of stimulus pulse geometry delivered in the subthalamic nucleus of Parkinson’s disease patients

Campbell,

Favi Bocca,

Tiefenbach

et al. 2023

Front. Neurol.

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IntroductionThe therapeutic efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson’s disease (PD) may be limited for some patients by the presence of stimulation-related side effects. Such effects are most often attributed to electrical current spread beyond the target region. Prior computational modeling studies have suggested that changing the degree of asymmetry of the individual phases of the biphasic, stimulus pulse may allow for more selective activation of neural elements in the target region. To the extent that different neural elements contribute to the therapeutic vs. side-effect inducing effects of DBS, such improved selectivity may provide a new parameter for optimizing DBS to increase the therapeutic window.MethodsWe investigated the effect of six different pulse geometries on cortical and myogenic evoked potentials in eight patients with PD whose leads were temporarily externalized following STN DBS implant surgery. DBS-cortical evoked potentials were quantified using peak to peak measurements and wavelets and myogenic potentials were quantified using RMS.ResultsWe found that the slope of the recruitment curves differed significantly as a function of pulse geometry for both the cortical- and myogenic responses. Notably, this effect was observed most frequently when stimulation was delivered using a monopolar, as opposed to a bipolar, configuration.DiscussionManipulating pulse geometry results in differential physiological effects at both the cortical and neuromuscular level. Exploiting these differences may help to expand DBS’ therapeutic window and support the potential for incorporating pulse geometry as an additional parameter for optimizing therapeutic benefit.

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Section: Discussionmentioning

confidence: 99%

Section: Data Acquisitionmentioning

confidence: 99%

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Myogenic and cortical evoked potentials vary as a function of stimulus pulse geometry delivered in the subthalamic nucleus of Parkinson’s disease patients

Campbell,

Favi Bocca,

Tiefenbach

et al. 2023

Front. Neurol.

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“…As previously shown by our team, by adapting the number of trajectories by respecting the individual anatomical condition of the patient, we did not result in any hemorrhage in our patient cohort [ 14 ]. Other work completed by our group has shown the value of using MER during asleep procedures to identify and avoid the pyramidal tract [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…We included them because of the intraoperative testing under the anesthesia protocol as described in the “ Methods ” section. Intraoperatively microstimulation via MER electrodes (Inomed GmbH, Emmendingen, Germany) was used [ 14 , 28 ]. First, testing at low frequency stimulation at 4 Hz with 210–500 μs pulse width and up to 6 mA intensity followed by effective stimulation using 60 μs pulse width, 130 Hz frequency and stimulation amplitude up to 5 mA.…”

Section: Methodsmentioning

confidence: 99%

Anesthesia for deep brain stimulation system implantation: adapted protocol for awake and asleep surgery using microelectrode recordings

et al. 2022

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Purpose Deep brain stimulation (DBS), an effective treatment for movement disorders, usually involves lead implantation while the patient is awake and sedated. Recently, there has been interest in performing the procedure under general anesthesia (asleep). This report of a consecutive cohort of DBS patients describes anesthesia protocols for both awake and asleep procedures. Methods Consecutive patients with Parkinson’s disease received subthalamic nucleus (STN) implants either moderately sedated or while intubated, using propofol and remifentanil. Microelectrode recordings were performed with up to five trajectories after discontinuing sedation in the awake group, or reducing sedation in the asleep group. Clinical outcome was compared between groups with the UPDRS III. Results The awake group (n = 17) received 3.5 mg/kg/h propofol and 11.6 μg/kg/h remifentanil. During recording, all anesthesia was stopped. The asleep group (n = 63) initially received 6.9 mg/kg/h propofol and 31.3 μg/kg/h remifentanil. During recording, this was reduced to 3.1 mg/kg/h propofol and 10.8 μg/kg/h remifentanil. Without parkinsonian medications or stimulation, 3-month UPDRS III ratings (ns = 16 and 52) were 40.8 in the awake group and 41.4 in the asleep group. Without medications but with stimulation turned on, ratings improved to 26.5 in the awake group and 26.3 in the asleep group. With both medications and stimulation, ratings improved further to 17.6 in the awake group and 15.3 in the asleep group. All within-group improvements from the off/off condition were statistically significant (all ps < 0.01). The degree of improvement with stimulation, with or without medications, was not significantly different in the awake vs. asleep groups (ps > 0.05). Conclusion The above anesthesia protocols make possible an asleep implant procedure that can incorporate sufficient microelectrode recording. Together, this may increase patient comfort and improve clinical outcomes.

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Intraoperative DBS targeting of the globus pallidus internus by using motor evoked potentials

Trenado,

Nikolov,

Slotty

et al. 2024

Journal of the Neurological Sciences

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Motor Evoked Potentials Improve Targeting in Deep Brain Stimulation Surgery

Cited by 7 publications

References 13 publications

Myogenic and cortical evoked potentials vary as a function of stimulus pulse geometry delivered in the subthalamic nucleus of Parkinson’s disease patients

Myogenic and cortical evoked potentials vary as a function of stimulus pulse geometry delivered in the subthalamic nucleus of Parkinson’s disease patients

Anesthesia for deep brain stimulation system implantation: adapted protocol for awake and asleep surgery using microelectrode recordings

Intraoperative DBS targeting of the globus pallidus internus by using motor evoked potentials

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