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6 results

  • The Association of Dexmedetomidine with Firing Properties in Pallidal Neurons

  • Majid Gasim, Suneil K. Kalia, Mojgan Hodaie, Andres M. Lozano, Lakshmikumar Venkatraghavan, William D. Hutchison
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 48 / Issue 4 / July 2021
    Published online by Cambridge University Press:
    05 November 2020, pp. 525-533
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  • Background:

    Microelectrode recordings (MERs) are used during deep brain stimulation surgery (DBS) to optimize patient outcomes and provide a unique method of collecting data regarding neurological conditions. However, MERs can be affected by anesthetics such as dexmedetomidine. Little is known about the effects of dexmedetomidine (DEX) on the globus pallidus interna (GPi), a common target for DBS. The primary aim of this study is to investigate the hypothesis that DEX is associated with alterations in GPi MERs.

    Methods:

    We conducted a retrospective analysis comparing MERs from patients with Parkinson’s disease (PD) and dystonia who underwent insertion of DBS of the GPi under DEX sedation with those who went through the same procedure without DEX (No DEX).

    Results:

    Firing rates for GPi neurons in the DEX group were lower (57.44 ± 2.04; mean ± SEM, n = 163 cells) than the No DEX group (69.53 ± 2.06, n = 112 cells, P < 0.0001). Overall, DEX was associated with a greater proportion of GPi cells classified as firing in bursty pattern compared to our No DEX group. (29.41%, n = 153 vs 14.81%, n = 108, P = 0.008). This effect was present for both PD and dystonia patients who underwent the procedure. High doses of DEX were associated with lower firing rates than low doses.

    Conclusions:

    Our results suggest that DEX is associated with a decrease in GPi firing rates and are associated with an increase in burstiness. Furthermore, these effects are similar between dystonia and PD patients. Lastly, the effects of DEX may differ between high doses and low doses.

  • Deep Brain Stimulation Target Selection for Parkinson’s Disease

  • Christopher R. Honey, Clement Hamani, Suneil K. Kalia, Tejas Sankar, Marina Picillo, Renato P. Munhoz, Alfonso Fasano, Michel Panisset
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 44 / Issue 1 / January 2017
    Published online by Cambridge University Press:
    15 March 2016, pp. 3-8
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  • During the “DBS Canada Day” symposium held in Toronto July 4-5, 2014, the scientific committee invited experts to discuss three main questions on target selection for deep brain stimulation (DBS) of patients with Parkinson’s disease (PD). First, is the subthalamic nucleus (STN) or the globus pallidus internus (GPi) the ideal target? In summary, both targets are equally effective in improving the motor symptoms of PD. STN allows a greater medications reduction, while GPi exerts a direct antidyskinetic effect. Second, are there further potential targets? Ventral intermediate nucleus DBS has significant long-term benefit for tremor control but insufficiently addresses other motor features of PD. DBS in the posterior subthalamic area also reduces tremor. The pedunculopontine nucleus remains an investigational target. Third, should DBS for PD be performed unilaterally, bilaterally or staged? Unilateral STN DBS can be proposed to asymmetric patients. There is no evidence that a staged bilateral approach reduces the incidence of DBS-related adverse events.