TY - JOUR
T1 - Propofol anesthesia precludes LFP-based functional mapping of pallidum during DBS implantation
AU - Malekmohammadi, Mahsa
AU - Sparks, Hiro
AU - Auyong, Nicholas
AU - Hudson, Andrew
AU - Pouratian, Nader
N1 - Funding Information:
This work was supported by the National Institutes of Biomedical Imaging and Bioengineering (K23 EB014326), National Institutes of Neurological Disorders and Stroke (R01NS097782), and philanthropic support from Casa Colina Centers for Rehabilitation. N.A. was supported by the National Institutes of Neurological Disorders and Stroke (R25-NS079198). M.M. was also supported by a postdoctoral fellowship from the American Parkinson Disease Association (APDA, NY, USA). The authors would like to thank patients who consented to participate in this study without whom recording of local field potentials would not have been possible.
Publisher Copyright:
© 2018 S. Karger AG, Basel.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Background/Aims: There are reports that microelectrode recording (MER) can be performed under certain anesthetized conditions for functional confirmation of the optimal deep brain stimulation (DBS) target. However, it is generally accepted that anesthesia affects MER. Due to a potential role of local field potentials (LFPs) in DBS functional mapping, we characterized the effect of propofol on globus pallidus interna (GPi) and externa (GPe) LFPs in Parkinson disease (PD) patients. Methods: We collected LFPs in 12 awake and anesthetized PD patients undergoing DBS implantation. Spectral power of β (13-35 Hz) and high-frequency oscillations (HFOs: 200-300 Hz) was compared across the pallidum. Results: Propofol suppressed GPi power by > 20 Hz while increasing power at lower frequencies. A similar power shift was observed in GPe; however, power in the high β range (20-35 Hz) increased with propofol. Before anesthesia both β and HFO activity were significantly greater at the GPi (χ 2 = 20.63 and χ 2 = 48.81, p < 0.0001). However, during anesthesia, we found no significant difference across the pallidum (χ 2 = 0.47, p = 0.79, and χ 2 = 4.11, p = 0.12). Conclusion: GPi and GPe are distinguishable using LFP spectral profiles in the awake condition. Propofol obliterates this spectral differentiation. Therefore, LFP spectra cannot be relied upon in the propofol-anesthetized state for functional mapping during DBS implantation.
AB - Background/Aims: There are reports that microelectrode recording (MER) can be performed under certain anesthetized conditions for functional confirmation of the optimal deep brain stimulation (DBS) target. However, it is generally accepted that anesthesia affects MER. Due to a potential role of local field potentials (LFPs) in DBS functional mapping, we characterized the effect of propofol on globus pallidus interna (GPi) and externa (GPe) LFPs in Parkinson disease (PD) patients. Methods: We collected LFPs in 12 awake and anesthetized PD patients undergoing DBS implantation. Spectral power of β (13-35 Hz) and high-frequency oscillations (HFOs: 200-300 Hz) was compared across the pallidum. Results: Propofol suppressed GPi power by > 20 Hz while increasing power at lower frequencies. A similar power shift was observed in GPe; however, power in the high β range (20-35 Hz) increased with propofol. Before anesthesia both β and HFO activity were significantly greater at the GPi (χ 2 = 20.63 and χ 2 = 48.81, p < 0.0001). However, during anesthesia, we found no significant difference across the pallidum (χ 2 = 0.47, p = 0.79, and χ 2 = 4.11, p = 0.12). Conclusion: GPi and GPe are distinguishable using LFP spectral profiles in the awake condition. Propofol obliterates this spectral differentiation. Therefore, LFP spectra cannot be relied upon in the propofol-anesthetized state for functional mapping during DBS implantation.
KW - Deep brain stimulation
KW - Functional mapping
KW - General anesthesia
KW - Globus pallidus
KW - Local field potentials
KW - Propofol
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U2 - 10.1159/000492231
DO - 10.1159/000492231
M3 - Article
C2 - 30196280
AN - SCOPUS:85053748644
SN - 1011-6125
VL - 96
SP - 249
EP - 258
JO - Stereotactic and Functional Neurosurgery
JF - Stereotactic and Functional Neurosurgery
IS - 4
ER -