Research Article| Volume 310, ISSUE 1-2, P44-49, November 15, 2011

Localization of the subthalamic nucleus in Parkinson disease using multiunit activity

Published:August 19, 2011DOI:



      Refinement of the subthalamic nucleus (STN) coordinates using intraoperative microelectrode recordings (MER) is routinely performed during deep brain stimulation (DBS) surgeries in Parkinson disease (PD). The commonly used criteria for electrophysiological localization of the STN are qualitative. The goal of this study was to validate quantitative STN detection algorithm (QD) derived from the multi-unit activity in a prospective setting.


      Ten PD patients underwent STN DBS surgery. The MUA was obtained by removing large spikes close to microelectrode using wavelet method and integrating the 500–2000 Hz band in the power spectral density. The qualitative intraoperative mapping of the STN using MER (IOM) versus QD was compared using Bland–Altman and Pearson's correlation analysis.


      The clinical efficacy was confirmed in all subjects. The mean difference between IOM and QD of the dorsal/ventral border was 0.31±0.84/0.44±0.47 mm. Using Bland–Altman statistic, only 2/36 (5.6%) differences (one for the dorsal border and one for the ventral border) were out of ±2 sd line of measurement differences. Correlation between dorsal border/ventral border positions obtained by IOM and QD was 0.79, p<0.0001/0.91, p<0.0001.


      Both methods are in reasonable agreement and are strongly correlated. The QD gives objective coordinates of the STN borders at high precision and may be more accurate than IOM. Prospective blinded comparative studies where the DBS leads will be placed using either QD or IOM are warranted.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Benabid A.L.
        • Chabardes S.
        • Mitrofanis J.
        • Pollak P.
        Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson's disease.
        Lancet Neurol. 2009; 8: 67-81
        • Marceglia S.
        • Mrakic-Sposta S.
        • Tommasi G.
        • Bartolomei L.
        • Foresti C.
        • Valzania F.
        • et al.
        Multicenter study report: electrophysiological monitoring procedures for subthalamic deep brain stimulation surgery in Parkinson's disease.
        Neurol Sci. 2010; 31: 449-457
        • Benazzouz A.
        • Breit S.
        • Koudsie A.
        • Pollak P.
        • Krack P.
        • Benadib A.L.
        Intraoperative microrecordings of the subthalamic nucleus in Parkinson's disease.
        Mov Disord. 2002; 17: S145-S149
        • Pesenti A.
        • Rohr M.
        • Egidi M.
        • Rampini P.
        • Tamma F.
        • Locatelli M.
        • et al.
        The subthalamic nucleus in Parkinson's disease: power spectral density analysis of neural intraoperative signals.
        Neurol Sci. 2004; 24: 367-374
        • Snellings A.
        • Sagher O.
        • Anderson D.J.
        • Aldridge J.W.
        Identification of the subthalamic nucleus in deep brain stimulation surgery with a novel wavelet-derived measure of neural background activity.
        J Neurosurg. 2009; 111: 767-774
        • Kano T.
        • Katayama Y.
        • Kobayashi K.
        • Kasai M.
        • Oshima H.
        • Fukaya C.
        • et al.
        Detection of boundaries of subthalamic nucleus by multiple-cell spike density analysis in deep brain stimulation for Parkinson's disease.
        Acta Neurochir Suppl. 2006; 99: 33-35
        • Moran A.
        • Gad I.B.
        • Bergman H.
        • Israel Z.
        Real-time refinement of subthalamic nucleus targeting using Bayesian decision-making on the root mean square measure.
        Mov Disord. 2006; 21: 1425-1431
        • Logothetis N.K.
        The underpinning of the BOLD functional magnetic resonance imaging signal.
        J Neurosci. 2003; 15: 3963-3971
        • Novak P.
        • Daniluk S.
        • Ellias S.A.
        • Nazzaro J.M.
        Detection of the subthalamic nucleus in microelectrographic recordings in Parkinson disease using the high-frequency (>500 Hz) neuronal background. Technical note.
        J Neurosurg. 2007; 106: 175-179
        • Shin M.
        • Lefaucheur J.P.
        • Penholate M.F.
        • Brugières P.
        • Gurruchaga J.M.
        • Nguyen J.P.
        Subthalamic nucleus stimulation in Parkinson's disease: postoperative CT–MRI fusion images confirm accuracy of electrode placement using intraoperative multi-unit recording.
        Neurophysiol Clin. 2007; 37: 457-466
        • Hughes A.J.
        • Daniel S.E.
        • Kilford L.
        • Lees A.J.
        Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases.
        J Neurol Neurosurg Psychiatry. 1992; 55: 181-184
        • Starr P.A.
        • Christine C.W.
        • Theodosopoulos P.V.
        • Lindsey N.
        • Byrd D.
        • Mosley A.
        • et al.
        Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations.
        J Neurosurg. 2002; 97: 370-387
        • Schaltenbrand G.
        • Wahren W.
        Atlas for stereotaxy of the human brain.
        Georg Thieme, Stuttgart1977
        • Donoho D.L.
        De-noising by soft-thresholding.
        IEEE Trans Inf Theory. 1995; 41: 613-627
        • Bland J.M.
        • Altman D.G.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 1: 307-310
        • Maks C.M.
        • Butson C.R.
        • Walter B.L.
        • Vitek J.L.
        • McIntyre C.C.
        Deep brain stimulation activation volumes and their association with neurophysiological mapping and therapeutic outcomes.
        J Neurol Neurosurg Psychiatry. 2009; 80: 659-666
        • Garonzik I.M.
        • Sherwin E.H.
        • Ohara S.
        • Lenz F.A.
        Intraoperative microelectrode and semi-microelectrode recording during the physiological localization of the thalamic nucleus ventral intermediate.
        Mov Disord. 2002; 17: S135-S144