Stereotactic Awake Basal Ganglia Electrophysiological Recording and Stimulation (SABERS): A Novel Staged Procedure for Personalized Targeting of Deep Brain Stimulation in Pediatric Movement and Neuropsychiatric Disorders

Mark A Liker; Terence D Sanger; Jennifer A MacLean; Jaya Nataraj; Enrique Arguelles; Mark Krieger; Aaron Robison; Joffre Olaya

doi:10.1177/08830738231224057

Stereotactic Awake Basal Ganglia Electrophysiological Recording and Stimulation (SABERS): A Novel Staged Procedure for Personalized Targeting of Deep Brain Stimulation in Pediatric Movement and Neuropsychiatric Disorders

J Child Neurol. 2024 Feb 26:8830738231224057. doi: 10.1177/08830738231224057. Online ahead of print.

Authors

Mark A Liker^{1

2}, Terence D Sanger^{3

4

5

6}, Jennifer A MacLean^{4

6}, Jaya Nataraj³, Enrique Arguelles⁷, Mark Krieger^{2

8}, Aaron Robison⁹, Joffre Olaya^{1

10}

Affiliations

¹ Divison of Neurosurgery, Children's Hospital of Orange County, Orange, CA, USA.
² Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
³ Samueli School of Engineering, University of California Irvine, Irvine, CA, USA.
⁴ Research Institute, Children's Hospital of Orange County, Orange, CA, USA.
⁵ Department of Pediatrics, School of Medicine, University of California Irvine, Irvine, CA, USA.
⁶ Department of Neurology, Children's Hospital of Orange County, Orange, CA, USA.
⁷ Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA.
⁸ Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
⁹ Department of Neurosurgery, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
¹⁰ Department of Neurological Surgery, School of Medicine, University of California Irvine, Irvine, CA, USA.

PMID: 38409793
DOI: 10.1177/08830738231224057

Abstract

Selection of targets for deep brain stimulation (DBS) has been based on clinical experience, but inconsistent and unpredictable outcomes have limited its use in patients with heterogeneous or rare disorders. In this large case series, a novel staged procedure for neurophysiological assessment from 8 to 12 temporary depth electrodes is used to select targets for neuromodulation that are tailored to each patient's functional needs. Thirty children and young adults underwent deep brain stimulation target evaluation with the new procedure: Stereotactic Awake Basal ganglia Electrophysiological Recording and Stimulation (SABERS). Testing is performed in an inpatient neuromodulation monitoring unit over 5-7 days, and results guide the decision to proceed and the choice of targets for permanent deep brain stimulation implantation. Results were evaluated 3-6 months postoperatively with the Burke-Fahn-Marsden Dystonia Rating Scale and the Barry-Albright Dystonia Scale. Stereotactic Awake Basal ganglia Electrophysiological Recording and Stimulation testing allowed modulation to be tailored to specific neurologic deficits in a heterogeneous population, including subjects with primary dystonia, secondary dystonia, and Tourette syndrome. All but one subject were implanted with 4 permanent deep brain stimulation leads. Results showed significant improvement on both scales at postoperative follow-up. No significant adverse events occurred. Use of the Stereotactic Awake Basal ganglia Electrophysiological Recording and Stimulation protocol with evaluation in the neuromodulation monitoring unit is feasible and results in significant patient benefit compared with previously published results in these populations. This new technique supports a significant expansion of functional neurosurgery to predict effective stimulation targets in a wide range of disorders of brain function, including those for which the optimal target is not yet known.

Keywords: Tourette syndrome; deep brain stimulation; dystonia; movement disorders; neuromodulation; pediatric.