Neural signal analysis for deep brain stimulation of Parkinson's disease
Parkinson's disease is a chronic neurodegenerative disease that affects the central nervous system due to the degeneration of the basal ganglia and substantia nigra in the brain, which results in the inability to produce enough dopamine. It mainly affects the motor nervous system , and symptoms usually appear slowly over time. The most obvious early symptoms are tremors , limb stiffness , motor function decline , and gait abnormalities . There may also be cognitive and behavioral problems. Dementia is quite common in patients with severe illness, and more than one-third of cases also develop major depressive disorder and anxiety . Other possible accompanying symptoms include problems with perception, sleep , and emotions .
Median Nerve Stimulation Facilitates the Identification of Somatotopy of the Subthalamic Nucleus in Parkinson’s Disease Patients under Inhalational Anesthesia
Abstract: Deep brain stimulation (DBS) improves Parkinson’s disease (PD) symptoms by suppressing neuropathological oscillations. These oscillations are also modulated by inhalational anesthetics used during DBS surgery in some patients, influencing electrode placement accuracy. We sought to evaluate a method that could avoid these effects. We recorded subthalamic nucleus (STN) neuronal firings in 11 PD patients undergoing DBS under inhalational anesthesia. Microelectrode recording (MER) during DBS was collected under median nerve stimulation (MNS) was delivered at 5, 20, 90 Hz frequencies and without MNS. We analyzed the spike firing rate and neuronal activity with power spectral density (PSD), and assessed correlations of neuronal oscillation parameters with clinical motor outcomes. No patient experienced adverse effects during or after DBS surgery. PSD analysis revealed that peripheral 20 Hz MNS produced significant differences in the dorsal and ventral subthalamic nucleus (STN) between the beta band oscillation (16.9% ± 7.0% versus 13.5% ± 4.8%, respectively) and gamma band oscillation (56.0% ± 13.7% versus 66.3% ± 9.4%, respectively) (p < 0.05). Moreover, 20-Hz MNS entrained neural oscillation over the dorsal STN, which correlated positively with motor disabilities. MNS allowed localization of the sensorimotor STN and identifies neural characteristics under inhalational anesthesia. This paradigm may help identify an alternative method to facilitate STN identification and DBS surgery under inhalational anesthesia.
Sevoflurane and Parkinson's disease: tracking of subthalamic nucleus neuronal activity and deep brain stimulation surgery
General anesthetics-induced changes of electrical oscillations in the basal ganglia may render the identification of the stimulation targets difficult. The authors hypothesized that while sevoflurane anesthesia entrains coherent lower frequency oscillations, it does not affect the identification of the subthalamic nucleus and clinical outcome.
Sevoflurane general anesthesia decreased beta-frequency oscillations by inducing coherent lower frequency oscillations, comparable to the pattern seen in the scalp electroencephalogram. Nevertheless, sevoflurane-induced changes in electrical activity patterns did not reduce electrode placement accuracy and clinical effect. These observations suggest that microelectrode-guided deep brain stimulation under sevoflurane anesthesia is a feasible clinical option.
Sheng-Tzung Tsai, Guo-Fang Tseng, Chang-Chih Kuo, Tsung-Ying Chen,Shin-Yuan Chen*. Sevoflurane and Parkinson's Disease: Subthalamic Nucleus Neuronal Activity and Clinical Outcome of Deep Brain Stimulation._cc781905-5cde-3194-bb3b -136bad5cf58d_ Anesthesiology May 2020, Vol. 132, 1034–1044.
Desflurane and sevoflurane has differential effect on neurophysiological activity of subthalamic nucleus in Parkinson’s Disease
Desflurane and sevoflurane are commonly used during inhalational anaesthesia, but few studies have investigated their effects on deep cerebral neuronal activity. In addition, the association between subthalamic nucleus (STN) neurophysiology and general anaesthesia induced by volatile anaesthetics are not yet identified. This study aimed to identify differences in neurophysiological characteristics of the STN during comparable minimal alveolar concentration (MAC) desflurane and sevoflurane anaesthesia for deep brain stimulation (DBS) in patients with Parkinson's disease.
Neuronal firing rate was lower with desflurane (47.4 [26.7] Hz) than with sevoflurane (63.9 [36.5] Hz) anaesthesia (P<0.001). Sevoflurane entrained greater gamma oscillation power than desflurane (62.9% [0.9%] vs 57.0% [1.5%], respectively; P=0.002). There was greater coherence in the theta band of the desflurane group compared with the sevoflurane group (13% vs 6%, respectively). Anaesthetic choice did not differentially influence STN mapping accuracy or the clinical outcome of DBS electrode implantation.
Chen-Yu Chen, Shin-Yuan Chen,Tsung-Ying Chen, Jiann-I Pan, Sheng-Tzung Tsai*. Desflurane and sevoflurane differentially affect activity of the subthalamic nucleus in Parkinson's disease._cc781905 -5cde-3194-bb3b-136bad5cf58d_ British Journal of Anaesthesia (BJA) Volume 126, Issue 2, February 2021, Pages 477-485