• Michael J Bos, Ana Maria Alzate Sanchez, SmeetsAnouk Y J MAYJMDepartment of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands., Raffaella Bancone, Linda Ackermans, Anthony R Absalom, Wolfgang F Buhre, Mark J Roberts, and JanssenMarcus L FMLFSchool for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.Department of Neurology and Clinical Neurophysiology, Maastricht University Medical Center, Ma.
• Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands, michael.bos@mumc.nl.
• Stereotact Funct Neurosurg. 2019 Jan 1; 97 (4): 225-231.

BackgroundDeep brain stimulation (DBS) is an accepted treatment for patients with medication-resistant Tourette syndrome (TS). Sedation is commonly required during electrode implantation to attenuate anxiety, pain, and severe tics. Anesthetic agents potentially impair the quality of microelectrode recordings (MER). Little is known about the effect of these anesthetics on MER in patients with TS. We describe our experience with different sedative regimens on MER and tic severity in patients with TS.MethodsThe clinical records of all TS patients who underwent DBS surgery between 2010 and 2018 were reviewed. Demographic data, stimulation targets, anesthetic agents, perioperative complications, and MER from each hemisphere were collected and analyzed. Single-unit activity was identified by filtering spiking activity from broadband MER data and principal component analysis with K-means clustering. Vocal and motor tics which caused artifacts in the MER data were manually selected using visual and auditory inspection.ResultsSix patients underwent bilateral DBS electrode implantation. In all patients, the target was the anterior internal globus pallidus. Patient comfort and hemodynamic and respiratory stability were maintained with conscious sedation with one or more of the following anesthetic drugs: propofol, midazolam, remifentanil, clonidine, and dexmedetomidine. Good quality MER and clinical testing were obtained in 9 hemispheres of 6 patients. In 3 patients, MER quality was poor on one side.ConclusionCautiously applied sedative drugs can provide patient comfort, hemodynamic and respiratory stability, and suppress severe tics, with minimal interference with MER.© 2019 The Author(s) Published by S. Karger AG, Basel.

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