Abstract
Background
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: August 19, 2011
Identification
Copyright
© 2011 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
