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Awake Testing during Deep Brain Stimulation Surgery Predicts Postoperative Stimulation Side Effect Thresholds

1
Departments of Neurology and Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA
2
School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
3
Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294, USA
4
Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
5
Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA
6
Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
*
Author to whom correspondence should be addressed.
Brain Sci. 2019, 9(2), 44; https://doi.org/10.3390/brainsci9020044
Received: 28 January 2019 / Revised: 12 February 2019 / Accepted: 13 February 2019 / Published: 18 February 2019
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Abstract

Despite substantial experience with deep brain stimulation for movement disorders and recent interest in electrode targeting under general anesthesia, little is known about whether awake macrostimulation during electrode targeting predicts postoperative side effects from stimulation. We hypothesized that intraoperative awake macrostimulation with the newly implanted DBS lead predicts dose-limiting side effects during device activation in clinic. We reviewed 384 electrode implants for movement disorders, characterized the presence or absence of stimulus amplitude thresholds for dose-limiting DBS side effects during surgery, and measured their predictive value for side effects during device activation in clinic with odds ratios ±95% confidence intervals. We also estimated associations between voltage thresholds for side effects within participants. Intraoperative clinical response to macrostimulation led to adjustments in DBS electrode position during surgery in 37.5% of cases (31.0% adjustment of lead depth, 18.2% new trajectory, or 11.7% both). Within and across targets and disease states, dose-limiting stimulation side effects from the final electrode position in surgery predict postoperative side effects, and side effect thresholds in clinic occur at lower stimulus amplitudes versus those encountered in surgery. In conclusion, awake clinical testing during DBS targeting impacts surgical decision-making and predicts dose-limiting side effects during subsequent device activation. View Full-Text
Keywords: awake behavioral testing; deep brain stimulation; movement disorders awake behavioral testing; deep brain stimulation; movement disorders
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Walker, H.C.; Faulk, J.; Rahman, A.F.; Gonzalez, C.L.; Roush, P.; Nakhmani, A.; Crowell, J.L.; Guthrie, B.L. Awake Testing during Deep Brain Stimulation Surgery Predicts Postoperative Stimulation Side Effect Thresholds. Brain Sci. 2019, 9, 44.

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