Intraoperative DBS targeting of the globus pallidus internus by using motor evoked potentials

Carlos Trenado; Petyo Nikolov; Philipp J Slotty; Jan Vesper; Alfons Schnitzler; Stefan Jun Groiss

doi:10.1016/j.jns.2024.123141

Intraoperative DBS targeting of the globus pallidus internus by using motor evoked potentials

J Neurol Sci. 2024 Aug 15:463:123141. doi: 10.1016/j.jns.2024.123141. Epub 2024 Jul 15.

Authors

Carlos Trenado¹, Petyo Nikolov², Philipp J Slotty³, Jan Vesper⁴, Alfons Schnitzler², Stefan Jun Groiss⁵

Affiliations

¹ Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Max Planck Institute for Empirical Aesthetics, Frankfurt am Main, Germany.
² Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
³ Department of Orthopaedics, Trauma Surgery and Hand Unit, Helios Klinikum Krefeld, Krefeld, Germany; Department of Functional Neurosurgery and Stereotaxy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Faculty of Medicine, Heinrich Heine University, Düsseldorf, Germany.
⁴ Department of Functional Neurosurgery and Stereotaxy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
⁵ Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Neurocenter Düsseldorf, Düsseldorf, Germany. Electronic address: groiss@uni-duesseldorf.de.

PMID: 39043070
DOI: 10.1016/j.jns.2024.123141

Abstract

Objectives: Target localization for deep brain stimulation (DBS) is a crucial step that influences the clinical benefit of the DBS procedure together with the reduction of side effects. In this work, we address the feasibility of DBS target localization in the globus pallidus internus (GPi) aided by intraoperative motor evoked potentials (MEP) with emphasis on the reduction of capsular side effects.

Material and methods: Micro-macroelectrode recordings were performed intraoperatively on 20 patients that underwent DBS treatment of the GPi (GPi-DBS). MEP were elicited intraoperatively by microelectrode stimulation during stereotactic DBS surgery. We studied the relationship between MEP thresholds and the internal capsule (IC) proximity.

Results: We found a significant correlation between intraoperative MEP thresholds and IC proximity.

Conclusions: We provide further evidence of the role of MEPs for DBS target localization in the GPi, which extends and confirms the usefulness of MEPs as previously reported by DBS target localization studies dealing with the subthalamic and thalamic nuclei. Our approach is advantageous in that it provides criteria to determine the DBS target without the need to rely on a patient's response while avoiding capsular effects.

Keywords: Capsular side effects; Deep brain stimulation; Globus pallidus; Motor evoked potentials.

MeSH terms

Adult
Aged
Deep Brain Stimulation* / methods
Evoked Potentials, Motor* / physiology
Female
Globus Pallidus* / physiology
Humans
Intraoperative Neurophysiological Monitoring / methods
Male
Middle Aged
Parkinson Disease / physiopathology
Parkinson Disease / therapy