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. 2021 Dec 24:12:775784.
doi: 10.3389/fneur.2021.775784. eCollection 2021.

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

Victor J Geraedts  1   2 , Rogier A P van Ham  1 , Jacobus J van Hilten  1 , Arne Mosch  3 , Carel F E Hoffmann  4 , Niels A van der Gaag  4   5 , Maria Fiorella Contarino  1   3
Affiliations

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

Victor J Geraedts et al. Front Neurol. .

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.

Keywords: GPi; Vim; deep brain stimulation (DBS); intraoperative test stimulation; monopolar contact review.

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Conflict of interest statement

Unrelated to this study, JH reports grants from The Netherlands Organisation for Health Research and Development, The Netherlands Organisation for Scientific Research, Hoffmann-La Roche, AbbVie, Lundbeck, Hersenstichting, Stichting Parkinson Fonds, Alkemade-Keuls Foundation, and Centre of Human Drug Research. AM reports travel support from Boston Scientific. CH reports travel support from Boston Scientific. NG reports travel support from Boston Scientific. MC reports support for advisory board from Medtronic (fees to institution), consultancy fees: Medtronic (fees to institution), CHDR (fees to institution), research support: Medtronic (to institution), AbbVie (to institution), research support in kind from Global Kinetics Corporation, travel support: Boston Scientific. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Paired analyses for the induction of capsular and non-capsular side-effects. (A) GPi DBS: induction of capsular side-effects (IO > PO: n = 20; IO < PO: n = 23; IO = PO: n = 5; mean ± SD threshold IO: 3.3 ± 1.1 mA, PO: 3.2 ± 1.0 mA, mean ± SD difference 1.0 ± 0.9 mA); (B) GPi DBS: induction of non-capsular side-effects (IO > PO: n = 5, IO < PO: n = 2, IO = PO: n = 2; mean ± SD threshold IO: 3.5 ± 1.0 mA, PO: 3.1 ± 0.9 mA, mean ± SD difference 0.6 ± 0.4 mA); (C) Vim DBS: induction of capsular side-effects (IO > PO: n = 23; IO < PO: n = 23; IO = PO: n = 14; mean ± SD threshold IO: 3.2 ± 0.9 mA, PO: 3.1 ± 0.8 mA, mean ± SD difference 0.8 ± 0.6 mA); (D) Vim DBS: induction of non-capsular side-effects (IO > PO: n = 14; IO < PO: n = 26; IO = PO: n = 7; mean ± SD threshold IO: 2.1 ± 1.0 mA, PO: 2.3 ± 0.9 mA, mean ± SD difference 0.9 ± 0.6 mA). The thickness of the lines reflects the number of paired observations. IO, intraoperative; PO, postoperative.
Figure 2
Figure 2
Unpaired survival analyses for the induction of capsular and non-capsular side-effects. (A) GPi DBS: induction of capsular side-effects; (B) GPi DBS: induction of non-capsular side-effects; (C) Vim DBS: induction of capsular side-effects; (D) Vim DBS: induction of non-capsular side-effects. Dashed line: intraoperative assessment; continuous line: postoperative assessment. Vertical ticks indicate censoring.
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