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Intraoperative vs. Postoperative Side-Effects-Thresholds During Pallidal and Thalamic DBS
Victor J Geraedts1,2, Rogier A P van Ham1, Jacobus J van Hilten1
1Department of Neurology, Leiden University Medical Center (LUMC), Leiden, Netherlands.
Frontiers in Neurology
|January 10, 2022
Summary
Intraoperative test stimulation for Deep Brain Stimulation (DBS) in the globus pallidus interna (GPi) and ventral intermediate nucleus (Vim) showed no significant differences in side-effect thresholds compared to chronic stimulation. However, individual patient data showed high variability, preventing direct extrapolation.
Area of Science:
- Neurosurgery
- Neurology
- Biomedical Engineering
Background:
- Deep Brain Stimulation (DBS) is a therapeutic intervention for neurological disorders.
- Intraoperative testing of DBS leads is crucial for optimizing stimulation parameters.
- The comparability of intraoperative test stimulation to chronic stimulation outcomes remains unclear.
Purpose of the Study:
- To compare side-effect thresholds identified during intraoperative test stimulation with those observed during chronic stimulation.
- To determine if intraoperative findings predict postoperative stimulation effects in GPi and Vim DBS.
Main Methods:
- Analysis of patient records undergoing GPi or Vim DBS.
- Comparison of thresholds for capsular and non-capsular side-effects at matched depths and group levels.
- Statistical analysis including linear mixed-effect models and unpaired survival analyses.
Main Results:
- Fifty-two patients (20 GPi, 32 Vim) were analyzed.
- No significant differences in side-effect induction between intraoperative and postoperative assessments at matched depths.
- Ventral intermediate nucleus (Vim) DBS showed significantly lower thresholds for side-effects.
- High variability observed, precluding direct extrapolation of thresholds at the individual level.
Conclusions:
- Intraoperative and postoperative assessments of GPi and Vim DBS are comparable in terms of side-effect thresholds.
- Significant variability exists, limiting the direct extrapolation of stimulation thresholds for individual patients.
- Further research may be needed to refine predictive models for DBS lead placement and programming.
