Przybyszewski A W, Ravin P, Pilitsis J G, Szymanski A, Barborica A, Novak P
Dept. of Neurology, University of Massachusetts, Medical School, Worcester, MA, USA; Polish-Japanese Academy of Information Technology, Warsaw, Poland.
Dept. of Neurology, UCLA School of Medicine, Los Angeles, USA.
J Neurol Sci. 2016 Jul 15;366:37-43. doi: 10.1016/j.jns.2016.04.043. Epub 2016 Apr 23.
Initial subthalamic nucleus (STN) localization is based on MRI and an anatomical atlas and then refined intraoperatively using electrophysiological mapping with microelectrode recordings (IOA - intraoperative multi-unit activity) during deep brain stimulation (DBS) in Parkinson's disease (PD). IOA is time consuming and subjective. The purpose of this study was to assess the value of high frequency multi-unit background activity (MUA, frequency >500Hz), and local field potentials (LFP, frequency 5-500Hz) in detection of the STN borders.
This was a retrospective, single center study. 18 leads in ten PD patients that underwent STN DBS surgery were evaluated. IOA, MUA and LFP have been compared in detection of the STN. IOA using single train spikes analysis have been used as a gold standard.
Both LFP in beta range (20-35Hz) and MUA increased as the microelectrode entered the STN and their increase correlated with dorsal/ventral STN borders. The differences (mean±sd) were: between IOA and MUA of the dorsal/ventral border 0.20±0.76/0.28±0.30mm; between IOA and LFP of the dorsal/ventral border 0.08±0.94/0.05±0.53mm. Using Bland-Altman statistics, only 2/36 (5.6%) differences between IOA and MUA and also 2/36 differences between IOA and LFP (one for the dorsal border and one for the ventral border) were out of ±1.96 SD line of measurement differences. Correlation between dorsal border/ventral border positions obtained by IOA and MUA was 0.86, p<0.000005/0.97, p<10(-11); by IOA and LFP was 0.78, p<0.00015/0.88, p<0.000001.
Both MUA and LFP are characteristically elevated in the STN compared to neighboring structures. They may provide fast, real-time, objective and reliable markers of STN borders.
帕金森病（PD）患者进行脑深部电刺激（DBS）时，丘脑底核（STN）的初始定位基于磁共振成像（MRI）和解剖图谱，然后在术中使用微电极记录的电生理图谱（IOA - 术中多单元活动）进行细化。IOA既耗时又主观。本研究的目的是评估高频多单元背景活动（MUA，频率>500Hz）和局部场电位（LFP，频率5 - 500Hz）在检测STN边界中的价值。
这是一项回顾性单中心研究。对10例接受STN DBS手术的PD患者的18根电极进行了评估。比较了IOA、MUA和LFP在检测STN方面的情况。使用单串脉冲分析的IOA被用作金标准。
当微电极进入STN时，β频段（20 - 35Hz）的LFP和MUA均增加，且它们的增加与STN的背侧/腹侧边界相关。差异（均值±标准差）为：背侧/腹侧边界处IOA与MUA之间为0.20±0.76/0.28±0.30mm；背侧/腹侧边界处IOA与LFP之间为0.08±0.94/0.05±0.53mm。使用Bland - Altman统计分析，IOA与MUA之间只有2/36（5.6%）的差异以及IOA与LFP之间也有2/36的差异（一个是背侧边界的差异，一个是腹侧边界的差异）超出了测量差异的±1.96标准差线。IOA与MUA获得的背侧边界/腹侧边界位置之间的相关性为0.86，p<0.000005/0.97，p<10⁻¹¹；IOA与LFP之间的相关性为0.78，p<0.00015/0.88，p<0.000001。
与相邻结构相比，STN中的MUA和LFP均有特征性升高。它们可能提供快速、实时、客观且可靠的STN边界标记。
