Abstract
Deep brain stimulation (DBS) requires a precise localization, which is especially difficult at the hypothalamus, because it is usually performed in anesthetized patients. We aimed to characterize the neurophysiological properties posteromedial hypothalamus (PMH), identified by the best neurophysiological response to electrical stimulation. We obtained microelectrode recordings from four patients with intractable aggressivity operated under general anesthesia. We pooled data from 1.5 mm at PMH, 1.5 mm upper (uPMH) and 1.5 mm lower (lPMH). We analyzed 178 units, characterized by the mean action potential (mAP). Only 11% were negative. We identified the next types of units: P1N1 (30.9%), N1P1N2 (29.8%), P1P2N1 (16.3%), N1P1 and N1N2P1 (6.2%) and P1N1P2 (5.0%). Besides, atypical action potentials (amAP) were recorded in 11.8%. PMH was highly different in cell composition from uPMH and lPMH, exhibiting also a higher percentage of amAP. Different kinds of cells shared similar features for the three hypothalamic regions. Although features for discharge pattern did not show region specificity, the probability mass function of inter-spike interval were different for all the three regions. Comparison of the same kind of mAP with thalamic neurons previously published demonstrate that most of cells are different for derivatives, amplitude and/or duration of repolarization and depolarization phases and also for the first phase, demonstrating a highly specificity for both brain centers. Therefore, the different properties described for PMH can be used to positively refine targeting, even under general anesthesia. Besides, we describe by first time the presence of atypical extracellular action potentials.
Highlights
The human hypothalamus is a complex structure composed of different nuclear groups [1]
When surgery is performed in the thalamus, subthalamus or globus pallidus, other physiological tests in addition to Microelectrode recording (MER) can be performed to identify nuclei, such as cellular responses to voluntary or passive movements, tactile stimuli or paraesthesia induced by electrical stimulation [9,10,11]
We analyzed the structure of mean action potential (mAP), which is defined as the arrangement of the parts composing all the waveforms
Summary
The human hypothalamus is a complex structure composed of different nuclear groups [1]. Microelectrode recording (MER) is a useful tool used during DBS surgery to identify deep brain nuclei [5,6,7,8]. When surgery is performed in the thalamus, subthalamus or globus pallidus, other physiological tests in addition to MER can be performed to identify nuclei, such as cellular responses to voluntary or passive movements, tactile stimuli or paraesthesia induced by electrical stimulation [9,10,11]. In the hypothalamus, these stimuli are not useful because the neural systems needed are not placed near, and the only electrophysiological help is the response to electrical stimulation [3,12,13]
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