title: Effect of intraoperative subthalamic nucleus DBS on human single-unit activity in the ipsilateral and contralateral subthalamic nucleus.
abstract: OBJECTIVE
  Insight may be gained into the physiological mechanisms of deep brain stimulation (DBS) by analyzing local and contralateral subthalamic nucleus (STN) single-unit activity during activation of previously placed DBS electrodes. Special techniques are required to perform such analysis due to the presence of a large stimulus artifact. The purpose of this study was to determine the effects of DBS stimulation on single unit activity acquired from patients undergoing new or revised DBS placements.
  
  
  METHODS
  Subthalamic nucleus single unit activity was acquired from awake patients during activation of a previously implanted STN DBS electrode. Stimulation was contralateral to the recording site in 4 cases and ipsilateral in 3. Data were acquired at stimulation frequencies of 30, 60, and 130 Hz and with other stimulation parameters at clinically effective settings. Cells were included if they showed kinesthetic activity before and after the stimulation paradigm and if their action potential morphology was maintained throughout the experiment. Analysis of single-unit activity acquired before, during, and after stimulation was performed employing a time-domain algorithm to overcome the stimulus artifact.
  
  
  RESULTS
  Both ipsilateral and contralateral acute stimulation resulted in reversible STN firing rate suppression. The degree of suppression became greater as stimulus frequency increased and was significant at 60 Hz (t-test, p < 0.05) and 130 Hz (p < 0.01). Suppression with ipsilateral 130-Hz stimulation ranged between 52.8% and 99.8%, whereas with similar contralateral STN stimulation, the range was lower (1.9%-50.3%). Return to baseline activity levels typically occurred within seconds after stimulation ended.
  
  
  CONCLUSIONS
  Stimulation of the STN at clinically effective frequencies has an acute suppressive rather than an excitatory effect on STN single-unit activity. The effect is bilateral, even though the degree of suppression is greater on the ipsilateral than the contralateral STN. The authors' algorithm helps reveal this effect in human patients.
authors.affiliation: Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois 60612, USA.
authors.forename: J Richard
authors.initials: JR
authors.lastname: Toleikis
authors.forename: Leo Verhagen
authors.initials: LV
authors.lastname: Metman
authors.forename: Julie G
authors.initials: JG
authors.lastname: Pilitsis
authors.forename: Andrei
authors.initials: A
authors.lastname: Barborica
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Toleikis
authors.forename: Roy A E
authors.initials: RA
authors.lastname: Bakay
mesh_terms: D000200:Action Potentials / Q000502:physiology; D000368:Aged; D000465:Algorithms; D016477:Artifacts; D001931:Brain Mapping; D003627:Data Interpretation, Statistical; D046690:Deep Brain Stimulation / Q000379:methods*; D004558:Electric Stimulation; D004567:Electrodes, Implanted; D055724:Electrophysiological Phenomena; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D007432:Intraoperative Period; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009474:Neurons / Q000502:physiology*; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy; D020531:Subthalamic Nucleus / Q000166:cytology / Q000502:physiology*