Electrophysiological characterization of the hyperdirect pathway and its functional relevance for subthalamic deep brain stimulation

Exp Neurol. 2022 Jun;352:114031. doi: 10.1016/j.expneurol.2022.114031. Epub 2022 Mar 2.


The subthalamic nucleus (STN) receives input from various cortical areas via hyperdirect pathway (HDP) which bypasses the basal-ganglia loop. Recently, the HDP has gained increasing interest, because of its relevance for STN deep brain stimulation (DBS). To understand the HDP's role cortical responses evoked by STN-DBS have been investigated. These responses have short (<2 ms), medium (2-15 ms), and long (20-70 ms) latencies. Medium-latency responses are supposed to represent antidromic cortical activations via HDP. Together with long-latency responses the medium responses can potentially be used as biomarker of DBS efficacy as well as side effects. We here propose that the activation sequence of the cortical evoked responses can be conceptualized as high frequency oscillations (HFO) for signal analysis. HFO might therefore serve as marker for antidromic activation. Using existing knowledge on HFO recordings, this approach allows data analyses and physiological modeling to advance the pathophysiological understanding of cortical DBS-evoked high-frequency activity.

Keywords: Antidromic activation; High frequency oscillations; Signal-to-noise ratio; Stimulation evoked responses.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Basal Ganglia
  • Deep Brain Stimulation*
  • Reaction Time
  • Subthalamic Nucleus* / physiology