Intraoperative vs. Postoperative Side-Effects-Thresholds During Pallidal and Thalamic DBS

Frontiers in Neurology, vol. 12, pp. 775784

Abstract

Background: It is currently unknown whether results from intraoperative test stimulation of two types of Deep Brain Stimulation (DBS), either during awake pallidal (GPi) or thalamic (Vim), are comparable to the results generated by chronic stimulation through the definitive lead. Objective: To determine whether side-effects-thresholds from intraoperative test stimulation are indicative of postoperative stimulation findings. Methods: Records of consecutive patients who received GPi or Vim were analyzed. Thresholds for the induction of either capsular or non-capsular side-effects were compared at matched depths and at group-level. Results: Records of fifty-two patients were analyzed (20 GPis, 75 Vims). The induction of side-effects was not significantly different between intraoperative and postoperative assessments at matched depths, although a large variability was observed (capsular: GPi DBS: p = 0.79; Vim DBS: p = 0.68); non-capsular: GPi DBS: p = 0.20; and Vim DBS: p = 0.35). Linear mixed-effect models revealed no differences between intraoperative and postoperative assessments, although the Vim had significantly lower thresholds (capsular side-effects p = 0.01, non-capsular side-effects p < 0.01). Unpaired survival analyses demonstrated lower intraoperative than postoperative thresholds for capsular side-effects in patients under GPi DBS (p = 0.01), while higher intraoperative thresholds for non-capsular side-effects in patients under Vim DBS (p = 0.01). Conclusion: There were no significant differences between intraoperative and postoperative assessments of GPi and Vim DBS, although thresholds cannot be directly extrapolated at an individual level due to high variability.

Authors 7

1. Victor Jacobus Geraedts Aachen Department of Clinical Epidemiology Department of Neurology, Leiden University Medical Center (LUMC)

   Leiden University Medical Center

   Affiliation as printed

   Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, Netherlands

   Department of Neurology, Leiden University Medical Center (LUMC), Leiden, Netherlands

2. Rogier A. P. van Ham Aachen Department of Neurology, Leiden University Medical Center (LUMC)

   Leiden University Medical Center

   Affiliation as printed

   Department of Neurology, Leiden University Medical Center (LUMC), Leiden, Netherlands

3. Jacobus Johannes van Hilten Aachen Department of Neurology, Leiden University Medical Center (LUMC)

   Leiden University Medical Center

   Affiliation as printed

   Department of Neurology, Leiden University Medical Center (LUMC), Leiden, Netherlands

4. Arne Mosch

   Haga Hospital

   Affiliation as printed

   Department of Neurology, Haga Teaching Hospital, The Hague, Netherlands

5. Carel F. E. Hoffmann

   Haga Hospital

   Affiliation as printed

   Department of Neurosurgery, Haga Teaching Hospital, The Hague, Netherlands

6. Niels Anthony Van Der Gaag Aachen Department of Neurosurgery, Leiden University Medical Center

   Leiden University Medical Center · Haga Hospital

   Affiliation as printed

   Department of Neurosurgery, Haga Teaching Hospital, The Hague, Netherlands

   Department of Neurosurgery, Leiden University Medical Center (LUMC), Leiden, Netherlands

7. Maria Fiorella Contarino corresponding Aachen Department of Neurology, Leiden University Medical Center (LUMC)

   Leiden University Medical Center · Haga Hospital

   Affiliation as printed

   Department of Neurology, Haga Teaching Hospital, The Hague, Netherlands

   Department of Neurology, Leiden University Medical Center (LUMC), Leiden, Netherlands