Predicting Post-operative Dysarthria Using Intra-operative Tongue Depression at High Pulse Width Stimulation During Asleep Deep Brain Stimulation
Vivekanudeep Karri1, Kazuki Sakakura1, John Pearce1, Nathan Pertsch1, Qianyi Pu1, Freya Mehta1, Neepa Patel2, Sepehr Sani1
1Department of Neurosurgery, 2Department of Neurology, Rush University Medical Center
Objective:
To assess the significance of intraoperative tongue depression as a predictor for postoperative dysarthria during asleep deep brain stimulation (DBS).
Background:
Asleep DBS targeting the subthalamic nucleus (STN) for Parkinson’s disease (PD) is an alternative to awake DBS in efforts to reduce psychological burden on patients. One disadvantage is the inability to intraoperatively monitor side effects of asleep DBS like postoperative dysarthria. Identifying predictors of postoperative dysarthria during asleep DBS can potentially reduce its impact on a patient’s quality of life. We hypothesize that tongue depression during intraoperative stimulation testing could predict postoperative dysarthria.
Design/Methods:
We studied 21 PD patients who underwent asleep STN-DBS from January 2023 to January 2024. After DBS lead placement, test stimulation was applied at 90μs and 120μs (higher than therapeutic pulse width) with 1-6mA intensity, and the threshold for tongue depression was recorded. Postoperatively, dysarthria occurrence was evaluated using 60μs stimulation with 1-6mA intensity. Logistic regression analysis assessed the relationship between intraoperative tongue depression and postoperative dysarthria, with the cutoff determined by the Receiver Operating Characteristic (ROC) curve. The threshold for statistical significance was set at a p-value < 0.05.
Results:
Intraoperative tongue depression threshold at 90μs stimulation was significantly associated with postoperative dysarthria (p = 0.042, Odd's ratio (OR): 2.3, 95% confidence interval (CI): 1.03 – 5.3), with an ROC area under the curve (AUC) of 0.75 and cutoff value of 4.5mA (sensitivity 0.60, specificity 0.83). At 120μs, significant association was also found (p = 0.032, OR 2.4, 95% CI: 1.08 – 5.4), with an ROC AUC of 0.74 and cutoff of 3.75mA (sensitivity 0.82, specificity 0.67).
Conclusions:
Intraoperative high pulse width stimulation during asleep DBS may predict postoperative dysarthria.
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