Awake Testing during Deep Brain Stimulation Surgery Predicts Postoperative Stimulation Side Effect Thresholds
Despite substantial experience with deep brain stimulation for movement disorders and recent interest in electrode targeting under general anesthesia, little is known about whether awake macrostimulation during electrode targeting predicts postoperative side effects from stimulation. We hypothesized...
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| Format: | Article |
| Language: | English |
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MDPI AG
2019-02-01
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| Series: | Brain Sciences |
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| Online Access: | https://www.mdpi.com/2076-3425/9/2/44 |
| _version_ | 1828760355776495616 |
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| author | Harrison C. Walker Jesse Faulk AKM Fazlur Rahman Christopher L. Gonzalez Patrick Roush Arie Nakhmani Jason L. Crowell Barton L. Guthrie |
| author_facet | Harrison C. Walker Jesse Faulk AKM Fazlur Rahman Christopher L. Gonzalez Patrick Roush Arie Nakhmani Jason L. Crowell Barton L. Guthrie |
| author_sort | Harrison C. Walker |
| collection | DOAJ |
| description | Despite substantial experience with deep brain stimulation for movement disorders and recent interest in electrode targeting under general anesthesia, little is known about whether awake macrostimulation during electrode targeting predicts postoperative side effects from stimulation. We hypothesized that intraoperative awake macrostimulation with the newly implanted DBS lead predicts dose-limiting side effects during device activation in clinic. We reviewed 384 electrode implants for movement disorders, characterized the presence or absence of stimulus amplitude thresholds for dose-limiting DBS side effects during surgery, and measured their predictive value for side effects during device activation in clinic with odds ratios ±95% confidence intervals. We also estimated associations between voltage thresholds for side effects within participants. Intraoperative clinical response to macrostimulation led to adjustments in DBS electrode position during surgery in 37.5% of cases (31.0% adjustment of lead depth, 18.2% new trajectory, or 11.7% both). Within and across targets and disease states, dose-limiting stimulation side effects from the final electrode position in surgery predict postoperative side effects, and side effect thresholds in clinic occur at lower stimulus amplitudes versus those encountered in surgery. In conclusion, awake clinical testing during DBS targeting impacts surgical decision-making and predicts dose-limiting side effects during subsequent device activation. |
| first_indexed | 2024-12-11T01:12:43Z |
| format | Article |
| id | doaj.art-79127068e99a4ce2a476eb6cf985aae1 |
| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-12-11T01:12:43Z |
| publishDate | 2019-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj.art-79127068e99a4ce2a476eb6cf985aae12022-12-22T01:25:59ZengMDPI AGBrain Sciences2076-34252019-02-01924410.3390/brainsci9020044brainsci9020044Awake Testing during Deep Brain Stimulation Surgery Predicts Postoperative Stimulation Side Effect ThresholdsHarrison C. Walker0Jesse Faulk1AKM Fazlur Rahman2Christopher L. Gonzalez3Patrick Roush4Arie Nakhmani5Jason L. Crowell6Barton L. Guthrie7Departments of Neurology and Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USASchool of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USADepartment of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294, USADepartment of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USASchool of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USADepartment of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USADepartment of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USADepartment of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35294, USADespite substantial experience with deep brain stimulation for movement disorders and recent interest in electrode targeting under general anesthesia, little is known about whether awake macrostimulation during electrode targeting predicts postoperative side effects from stimulation. We hypothesized that intraoperative awake macrostimulation with the newly implanted DBS lead predicts dose-limiting side effects during device activation in clinic. We reviewed 384 electrode implants for movement disorders, characterized the presence or absence of stimulus amplitude thresholds for dose-limiting DBS side effects during surgery, and measured their predictive value for side effects during device activation in clinic with odds ratios ±95% confidence intervals. We also estimated associations between voltage thresholds for side effects within participants. Intraoperative clinical response to macrostimulation led to adjustments in DBS electrode position during surgery in 37.5% of cases (31.0% adjustment of lead depth, 18.2% new trajectory, or 11.7% both). Within and across targets and disease states, dose-limiting stimulation side effects from the final electrode position in surgery predict postoperative side effects, and side effect thresholds in clinic occur at lower stimulus amplitudes versus those encountered in surgery. In conclusion, awake clinical testing during DBS targeting impacts surgical decision-making and predicts dose-limiting side effects during subsequent device activation.https://www.mdpi.com/2076-3425/9/2/44awake behavioral testingdeep brain stimulationmovement disorders |
| spellingShingle | Harrison C. Walker Jesse Faulk AKM Fazlur Rahman Christopher L. Gonzalez Patrick Roush Arie Nakhmani Jason L. Crowell Barton L. Guthrie Awake Testing during Deep Brain Stimulation Surgery Predicts Postoperative Stimulation Side Effect Thresholds Brain Sciences awake behavioral testing deep brain stimulation movement disorders |
| title | Awake Testing during Deep Brain Stimulation Surgery Predicts Postoperative Stimulation Side Effect Thresholds |
| title_full | Awake Testing during Deep Brain Stimulation Surgery Predicts Postoperative Stimulation Side Effect Thresholds |
| title_fullStr | Awake Testing during Deep Brain Stimulation Surgery Predicts Postoperative Stimulation Side Effect Thresholds |
| title_full_unstemmed | Awake Testing during Deep Brain Stimulation Surgery Predicts Postoperative Stimulation Side Effect Thresholds |
| title_short | Awake Testing during Deep Brain Stimulation Surgery Predicts Postoperative Stimulation Side Effect Thresholds |
| title_sort | awake testing during deep brain stimulation surgery predicts postoperative stimulation side effect thresholds |
| topic | awake behavioral testing deep brain stimulation movement disorders |
| url | https://www.mdpi.com/2076-3425/9/2/44 |
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