Awake Testing to Confirm Target Engagement

Clinical testing of the awake patient during or prior to functional neurosurgical procedures such as deep brain stimulator (DBS) placement, focused ultrasound (FUS), or epilepsy surgeries is a valuable tool to verify that the appropriate target has been engaged for purposes of improving symptoms. This testing also serves to identify potential adverse effects of surgical therapy that may limit efficacy or lead to poor outcomes. The treating clinician should be familiar with both the regional anatomy and brain circuitry involved in these diseases states, as well as the testing sequences, parameters, and interpretation of results in order to make appropriate therapeutic decisions for individual patients. This chapter reviews testing patients with movement and neuropsychiatric disorders during DBS or FUS procedures and patients with epilepsy prior to surgical intervention.