Malekmohammadi Mahsa, Sparks Hiro, AuYong Nicholas, Hudson Andrew, Pouratian Nader
Department of Neurosurgery, University of California, Los Angeles, California, USA.
Department of Anesthesiology, University of California, Los Angeles, California, USA.
Stereotact Funct Neurosurg. 2018;96(4):249-258. doi: 10.1159/000492231. Epub 2018 Sep 7.
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.
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.
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 (χ2 = 20.63 and χ2 = 48.81, p < 0.0001). However, during anesthesia, we found no significant difference across the pallidum (χ2 = 0.47, p = 0.79, and χ2 = 4.11, p = 0.12).
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.
背景/目的：有报道称，在特定麻醉条件下可进行微电极记录（MER），以功能确认最佳的脑深部电刺激（DBS）靶点。然而，人们普遍认为麻醉会影响MER。由于局部场电位（LFP）在DBS功能映射中可能发挥作用，我们对丙泊酚对帕金森病（PD）患者内侧苍白球（GPi）和外侧苍白球（GPe）LFP的影响进行了特征描述。
我们收集了12例接受DBS植入的清醒和麻醉PD患者的LFP。比较了整个苍白球的β（13 - 35Hz）频段功率和高频振荡（HFOs：200 - 300Hz）。
丙泊酚使GPi功率在>20Hz时降低，而在较低频率时功率增加。在GPe中也观察到类似的功率变化；然而，在高β频段（20 - 35Hz），丙泊酚使功率增加。麻醉前，GPi处的β和HFO活动均显著更强（χ2 = 20.63和χ2 = 48.81，p < 0.0001）。然而，在麻醉期间，我们发现整个苍白球无显著差异（χ2 = 0.47，p = 0.79，χ2 = 4.11，p = 0.12）。
在清醒状态下，使用LFP频谱特征可区分GPi和GPe。丙泊酚消除了这种频谱差异。因此，在DBS植入过程中，在丙泊酚麻醉状态下不能依靠LFP频谱进行功能映射。
