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Motor Evoked Potential Recordings During Segmented Deep Brain Stimulation-A Feasibility Study.

Jay Shils1, Ryan B Kochanski2, Alireza Borghei2

  • 1Department of Anesthesia, Rush University Medical Center, Chicago, Illinois.

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Summary

Motor evoked potentials (MEPs) can assess corticospinal tract (CST) activation thresholds during deep brain stimulation (DBS) surgery. This technique helps identify optimal segmented DBS lead contacts for improved therapeutic outcomes.

Keywords:
Corticospinal tractDeep brain stimulationMotor evoked potentialSegmentedSubthalamic nucleus

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Area of Science:

  • Neurosurgery
  • Neurology
  • Biomedical Engineering

Background:

  • Segmented deep brain stimulation (DBS) leads offer directional current steering to widen the therapeutic window.
  • Directing current away from the corticospinal tract (CST) is crucial for minimizing side effects.
  • The intraoperative feasibility of using motor evoked potentials (MEPs) to quantify CST activation thresholds with segmented DBS leads remains unclear.

Purpose of the Study:

  • To determine the feasibility of using MEPs to identify CST activation thresholds for both ring and individual segments of DBS leads.
  • To assess the utility of MEPs in optimizing contact selection during DBS surgery under general anesthesia.

Main Methods:

  • MEP testing was conducted during pulse generator implantation in patients undergoing subthalamic nucleus (STN) DBS.
  • Stimulation of individual ring and segmented contacts of directional DBS leads was performed to determine CST threshold.
  • Stereotactic coordinates, CST thresholds, and activated muscle groups were systematically recorded.

Main Results:

  • MEP thresholds were successfully recorded from 268 contacts/segments across 34 hemispheres.
  • Differential CST thresholds were observed for segmented contacts, indicating varying responses based on segment orientation.
  • First dorsal interosseous and abductor pollicis brevis were the most frequently activated muscles.

Conclusions:

  • Intraoperative MEP threshold recording is feasible with segmented DBS leads.
  • MEP analysis can identify DBS lead segments with the highest CST thresholds.
  • This method may aid in determining optimal segment orientation relative to the CST for improved surgical precision.