Abstract
Background: It is currently unknown whether results from intraoperative test stimulation of two types of Deep Brain Stimulation (DBS), either during awake pallidal (GPi) or thalamic (Vim), are comparable to the results generated by chronic stimulation through the definitive lead.Objective: To determine whether side-effects-thresholds from intraoperative test stimulation are indicative of postoperative stimulation findings.Methods: Records of consecutive patients who received GPi or Vim were analyzed. Thresholds for the induction of either capsular or non-capsular side-effects were compared at matched depths and at group-level.Results: Records of fifty-two patients were analyzed (20 GPis, 75 Vims). The induction of side-effects was not significantly different between intraoperative and postoperative assessments at matched depths, although a large variability was observed (capsular: GPi DBS: p = 0.79; Vim DBS: p = 0.68); non-capsular: GPi DBS: p = 0.20; and Vim DBS: p = 0.35). Linear mixed-effect models revealed no differences between intraoperative and postoperative assessments, although the Vim had significantly lower thresholds (capsular side-effects p = 0.01, non-capsular side-effects p < 0.01). Unpaired survival analyses demonstrated lower intraoperative than postoperative thresholds for capsular side-effects in patients under GPi DBS (p = 0.01), while higher intraoperative thresholds for non-capsular side-effects in patients under Vim DBS (p = 0.01).Conclusion: There were no significant differences between intraoperative and postoperative assessments of GPi and Vim DBS, although thresholds cannot be directly extrapolated at an individual level due to high variability.
Highlights
Deep Brain Stimulation (DBS) is an effective treatment to alleviate symptoms of various movement disorders, including Parkinson’s disease (PD), dystonia, and Essential Tremor (ET), targeting either the subthalamic nucleus (STN), internal globus pallidus (GPi), or ventral intermediate nucleus of the thalamus (Vim) [1]
Post-operatively, both capsular (p < 0.001) and non-capsular (p < 0.001) side-effects occurred at lower thresholds in patients under Vim DBS than those under GPi DBS and Vim DBS (GPi DBS)
Non-capsular side-effects occurred at lower thresholds in patients under Vim DBS (p < 0.001); no difference was seen for capsular side-effects (p = 0.215)
Summary
Deep Brain Stimulation (DBS) is an effective treatment to alleviate symptoms of various movement disorders, including Parkinson’s disease (PD), dystonia, and Essential Tremor (ET), targeting either the subthalamic nucleus (STN), internal globus pallidus (GPi), or ventral intermediate nucleus of the thalamus (Vim) [1]. Test stimulation of the planned targets at several depths through the microelectrode macrostimulation tip is a common procedure in many centers to aid the placement of the definitive lead by evaluating the therapeutic effect of stimulation and the threshold for stimulation-induced side-effects [4] It is currently poorly understood whether results of this intraoperative test stimulation are comparable to the results post-operatively generated by chronic stimulation through the definitive lead. Other than STN in awake surgeries, are lacking, it is still unclear whether our results are specific to the STN or are generalizable to other targets and indications It is currently unknown whether results from intraoperative test stimulation of two types of Deep Brain Stimulation (DBS), either during awake pallidal (GPi) or thalamic (Vim), are comparable to the results generated by chronic stimulation through the definitive lead
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