Ethical and Practical Considerations for Human Microelectrode Recording Studies

Objective:To compare motor and nonmotor outcomes at 6 months of asleep deep brain stimulation (DBS) for Parkinson disease (PD) using intraoperative imaging guidance to confirm electrode placement vs awake DBS using microelectrode recording to confirm electrode placement.Methods:DBS candidates with PD referred to Oregon Health & Science University underwent asleep DBS with imaging guidance. Six-month outcomes were compared to those of patients who previously underwent awake DBS by the same surgeon and center. Assessments included an “off”-levodopa Unified Parkinson’s Disease Rating Scale (UPDRS) II and III, the 39-item Parkinson's Disease Questionnaire, motor diaries, and speech fluency.Results:Thirty participants underwent asleep DBS and 39 underwent awake DBS. No difference was observed in improvement of UPDRS III (+14.8 ± 8.9 vs +17.6 ± 12.3 points, p = 0.19) or UPDRS II (+9.3 ± 2.7 vs +7.4 ± 5.8 points, p = 0.16). Improvement in “on” time without dyskinesia was superior in asleep DBS (+6.4 ± 3.0 h/d vs +1.7 ± 1.2 h/d, p = 0.002). Quality of life scores improved in both groups (+18.8 ± 9.4 in awake, +8.9 ± 11.5 in asleep). Improvement in summary index (p = 0.004) and subscores for cognition (p = 0.011) and communication (p < 0.001) were superior in asleep DBS. Speech outcomes were superior in asleep DBS, both in category (+2.77 ± 4.3 points vs −6.31 ± 9.7 points (p = 0.0012) and phonemic fluency (+1.0 ± 8.2 points vs −5.5 ± 9.6 points, p = 0.038).Conclusions:Asleep DBS for PD improved motor outcomes over 6 months on par with or better than awake DBS, was superior with regard to speech fluency and quality of life, and should be an option considered for all patients who are candidates for this treatment.Clinicaltrials.gov identifier:NCT01703598.Classification of evidence:This study provides Class III evidence that for patients with PD undergoing DBS, asleep intraoperative CT imaging–guided implantation is not significantly different from awake microelectrode recording–guided implantation in improving motor outcomes at 6 months.

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Thalamic Microelectrode Recording and Microstimulation in Central and Deafferentation Pain

Stereotactic and Functional Neurosurgery ◽

10.1159/000100749 ◽

1987 ◽

Vol 50 (1-6) ◽

pp. 414-417 ◽

Cited By ~ 6

Author(s):

R.R. Tasker ◽

J. Gorecki ◽

F.A. Lenz ◽

T. Hirayama ◽

J.O. Dostrovsky

Keyword(s):

Microelectrode Recording ◽

Deafferentation Pain

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A metaanalysis comparing the results of pallidotomy performed using microelectrode recording or macroelectrode stimulation

Journal of Neurosurgery ◽

10.3171/jns.2002.96.6.1058 ◽

2002 ◽

Vol 96 (6) ◽

pp. 1058-1062 ◽

Cited By ~ 48

Author(s):

Ravikant S. Palur ◽

Caglar Berk ◽

Michael Schulzer ◽

Christopher R. Honey

Keyword(s):

Intracranial Hemorrhage ◽

Rating Scale ◽

Complication Rates ◽

Microelectrode Recording ◽

Content Type ◽

Medline Search ◽

Significant Difference ◽

Active Debate ◽

Unilateral Pallidotomy ◽

Fine Print

Object. There is an active debate regarding whether pallidotomy should be performed using macroelectrode stimulation or the more sophisticated and expensive method of microelectrode recording. No prospective, randomized trial results have answered this question, although personnel at many centers claim one method is superior. In their metaanalysis the authors reviewed published reports of both methods to determine if there is a significant difference in clinical outcomes or complication rates associated with these methods. Methods. A metaanalysis was performed with data from reports on the use of unilateral pallidotomy in patients with Parkinson disease (PD) that were published between 1992 and 2000. A Medline search was conducted for the key word “pallidotomy” and additional studies were added following a review of the references. Only those studies dealing with unilateral procedures performed in patients with PD were included. Papers were excluded if they described a cohort smaller than 10 patients or a follow-up period shorter than 3 months or included cases that previously had been reported. The primary end points for outcome were the percentages of improvement in dyskinesias and in motor scores determined by the Unified PD Rating Scale (UPDRS). Complications were categorized as mortality, intracranial hemorrhage, visual deficit, speech deficit, cognitive decline, weakness, and other. There were no significant differences between the two methods with respect to improvements in dyskinesias (p = 0.66) or UPDRS motor scores (p = 0.62). Microelectrode recording was associated with a significantly higher (p = 0.012) intracranial hemorrhage rate (1.3 ± 0.4%), compared with macroelectrode stimulation (0.25 ± 0.2%). Conclusions. In reports of patients with PD who underwent unilateral pallidotomy, operations that included microelectrode recording were associated with a small, but significantly higher rate of symptomatic intracranial hemorrhage; however, there was no difference in postoperative reduction of dyskinesia or bradykinesia compared with operations that included macroelectrode stimulation.

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Improvement in a quantitative measure of bradykinesia after microelectrode recording in patients with Parkinson's disease during deep brain stimulation surgery

Movement Disorders ◽

10.1002/mds.20796 ◽

2006 ◽

Vol 21 (5) ◽

pp. 673-678 ◽

Cited By ~ 48

Author(s):

Mandy Miller Koop ◽

Amy Andrzejewski ◽

Bruce C. Hill ◽

Gary Heit ◽

Helen M. Bronte-Stewart

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Quantitative Measure ◽

Microelectrode Recording ◽

Deep Brain Stimulation Surgery ◽

Deep Brain

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Inhibition of diuretic stimulation of an insect secretory epithelium by a cGMP-dependent protein kinase

AJP Renal Physiology ◽

10.1152/ajprenal.00231.2012 ◽

2013 ◽

Vol 304 (9) ◽

pp. F1210-F1216 ◽

Cited By ~ 7

Author(s):

Kristen A. Ruka ◽

Anna P. Miller ◽

Edward M. Blumenthal

Keyword(s):

Protein Kinase ◽

Stellate Cells ◽

Malpighian Tubules ◽

Microelectrode Recording ◽

Dependent Protein Kinase ◽

Rnai Construct ◽

Cgmp Dependent Protein Kinase ◽

Dependent Protein ◽

Diuretic Agents ◽

Stimulation Of

The rate of urine secretion by insect Malpighian tubules (MTs) is regulated by multiple diuretic and antidiuretic hormones, often working either synergistically or antagonistically. In the Drosophila melanogaster MT, only diuretic factors have been reported. Two such agents are the biogenic amine tyramine (TA) and the peptide drosokinin (DK), both of which act on the stellate cells of the tubule to increase transepithelial chloride conductance. In the current study, TA and DK signaling was quantified by microelectrode recording of the transepithelial potential in isolated Drosophila MTs. Treatment of tubules with cGMP caused a significant reduction in the depolarizing responses to both TA and DK, while cAMP had no effect on these responses. To determine whether a specific cGMP-dependent protein kinase (PKG) was mediating this inhibition, PKG expression was knocked down by RNAi in either the principal cells or the stellate cells. Knockdown of Pkg21D in the stellate cells eliminated the modulation of TA and DK signaling. Knockdown of Pkg21D with a second RNAi construct also reduced the modulation of TA signaling. In contrast, knockdown of the expression of foraging or CG4839, which encodes a known and a putative PKG, respectively, had no effect. These data indicate that cGMP, acting through the Pkg21D gene product in the stellate cells, can inhibit signaling by the diuretic agents TA and DK. This represents a novel function for cGMP and PKG in the Drosophila MT and suggests the existence of an antidiuretic hormone in Drosophila .

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