title: Dorsolateral subthalamic neuronal activity enhanced by median nerve stimulation characterizes Parkinson's disease during deep brain stimulation with general anesthesia.
abstract: OBJECTIVE
  Deep brain stimulation (DBS) surgery under general anesthesia is an alternative option for patients with Parkinson's disease (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 mated 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.
authors.affiliation: Departments of Neurosurgery and.|Departments of Medicine and.
authors.forename: Sheng-Tzung
authors.initials: ST
authors.lastname: Tsai
authors.affiliation: Department of Electrical Engineering, National Chiao-Tung University, Hsinchu, Taiwan.
authors.forename: Wei-Yi
authors.initials: WY
authors.lastname: Chuang
authors.affiliation: Physiology, Tzu Chi University, Hualien; and.
authors.forename: Chung-Chih
authors.initials: CC
authors.lastname: Kuo
authors.affiliation: Department of Electrical Engineering, National Chiao-Tung University, Hsinchu, Taiwan.
authors.forename: Paul C P
authors.initials: PC
authors.lastname: Chao
authors.affiliation: Anesthesiology, Buddhist Tzu Chi General Hospital, Hualien;|Departments of Medicine and.
authors.forename: Tsung-Ying
authors.initials: TY
authors.lastname: Chen
authors.affiliation: Departments of Neurosurgery and.
authors.forename: Hsiang-Yi
authors.initials: HY
authors.lastname: Hung
authors.affiliation: Departments of Neurosurgery and.|Departments of Medicine and.
authors.forename: Shin-Yuan
authors.initials: SY
authors.lastname: Chen
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D001931:Brain Mapping / Q000379:methods*; D046690:Deep Brain Stimulation; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve; D008839:Microelectrodes; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology* / Q000628:therapy; D020531:Subthalamic Nucleus / Q000503:physiopathology*
keywords: DBS = deep brain stimulation; ISI = interspike interval; LFP = local field potential; MAC = minimal alveolar concentration; MER = microelectrode recording; MNS = median nerve stimulation; PD = Parkinson’s disease; PSD = power spectral density; SSEP = somatosensory evoked potential; STN = subthalamic nucleus; UPDRS = Unified Parkinson’s Disease Rating Scale; deep brain stimulation; functional neurosurgery; general anesthesia; median nerve stimulation; microelectrode recording; subthalamic nucleus