Intraoperative localization of spatially and spectrally distinct resting-state networks in Parkinson’s disease

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  • 1 Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience;
  • | 2 Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research; and
  • | 3 Department for Neurodegenerative Diseases, and Hertie Institute for Clinical Brain Research, and German Centre of Neurodegenerative Diseases (DZNE), Eberhard Karls University Tübingen, Germany
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Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for symptomatic Parkinson’s disease (PD); the clinical benefit may not only mirror modulation of local STN activity but also reflect consecutive network effects on cortical oscillatory activity. Moreover, STN-DBS selectively suppresses spatially and spectrally distinct patterns of synchronous oscillatory activity within cortical-subcortical loops. These STN-cortical circuits have been described in PD patients using magnetoencephalography after surgery. This network information, however, is currently not available during surgery to inform the implantation strategy.

The authors recorded spontaneous brain activity in 3 awake patients with PD (mean age 67 ± 14 years; mean disease duration 13 ± 7 years) during implantation of DBS electrodes into the STN after overnight withdrawal of dopaminergic medication. Intraoperative propofol was discontinued at least 30 minutes prior to the electrophysiological recordings. The authors used a novel approach for performing simultaneous recordings of STN local field potentials (LFPs) and multichannel electroencephalography (EEG) at rest. Coherent oscillations between LFP and EEG sensors were computed, and subsequent dynamic imaging of coherent sources was performed.

The authors identified coherent activity in the upper beta range (21–35 Hz) between the STN and the ipsilateral mesial (pre)motor area. Coherence in the theta range (4–6 Hz) was detected in the ipsilateral prefrontal area.

These findings demonstrate the feasibility of detecting frequency-specific and spatially distinct synchronization between the STN and cortex during DBS surgery. Mapping the STN with this technique may disentangle different functional loops relevant for refined targeting during DBS implantation.

ABBREVIATIONS

DBS = deep brain stimulation; DICS = dynamic imaging of coherent sources; EEG = electroencephalography; LFP = local field potential; MEG = magnetoencephalography; OCD = obsessive-compulsive disorder; PD = Parkinson’s disease; STN = subthalamic nucleus.

Illustration from Duan et al. (pp 1174–1181).

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Contributor Notes

Correspondence Alireza Gharabaghi: Eberhard Karls University, Tübingen, Germany. alireza.gharabaghi@uni-tuebingen.de.

INCLUDE WHEN CITING Published online March 1, 2019; DOI: 10.3171/2018.11.JNS181684.

P.B. and R.A.A. contributed equally to this work.

Disclosures Dr. Gharabaghi has received clinical or research support from Medtronic, Abbott, Boston Scientific, the German Federal Ministry of Education and Research, and the Baden-Württemberg Foundation not related to this research. Dr. Weiss reports being a consultant for STADA Pharm. He has received clinical or research support from the following: Medtronic, Abbott, Boston Scientific, Michael J. Fox Foundation, and the German Research Council. He has also received grants and speaking honoraria from Medtronic, Abbott, Boston Scientific, Abbvie, Stada, and Licher.

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