**Influence of Anesthesia and Clinical Variables on the Firing Rate, Coe**ffi**cient of Variation and Multi-Unit Activity of the Subthalamic Nucleus in Patients with Parkinson's Disease**

**Michael J. Bos 1,2,\*,**†**, Ana Maria Alzate Sanchez 2,**†**, Ra**ff**aella Bancone 2, Yasin Temel 2,3, Bianca T.A. de Greef 2,4, Anthony R. Absalom 5, Erik D. Gommer 2,6, Vivianne H.J.M. van Kranen-Mastenbroek 2,6, Wolfgang F. Buhre 1,2, Mark J. Roberts 7 and Marcus L.F. Janssen 2,6**


Received: 24 March 2020; Accepted: 17 April 2020; Published: 24 April 2020

**Abstract:** Background: Microelectrode recordings (MER) are used to optimize lead placement during subthalamic nucleus deep brain stimulation (STN-DBS). To obtain reliable MER, surgery is usually performed while patients are awake. Procedural sedation and analgesia (PSA) is often desirable to improve patient comfort, anxiolysis and pain relief. The effect of these agents on MER are largely unknown. The objective of this study was to determine the effects of commonly used PSA agents, dexmedetomidine, clonidine and remifentanil and patient characteristics on MER during DBS surgery. Methods: Data from 78 patients with Parkinson's disease (PD) who underwent STN-DBS surgery were retrospectively reviewed. The procedures were performed under local anesthesia or under PSA with dexmedetomidine, clonidine or remifentanil. In total, 4082 sites with multi-unit activity (MUA) and 588 with single units were acquired. Single unit firing rates and coefficient of variation (CV), and MUA total power were compared between patient groups. Results: We observed a significant reduction in MUA, an increase of the CV and a trend for reduced firing rate by dexmedetomidine. The effect of dexmedetomidine was dose-dependent for all measures. Remifentanil had no effect on the firing rate but was associated with a significant increase in CV and a decrease in MUA. Clonidine showed no significant effect on firing rate, CV or MUA. In addition to anesthetic effects, MUA and CV were also influenced by patient-dependent variables. Conclusion: Our results showed that PSA influenced neuronal properties in the STN and the dexmedetomidine (DEX) effect was dose-dependent. In addition, patient-dependent characteristics also influenced MER.

**Keywords:** deep brain stimulation; microelectrode recordings; subthalamic nucleus; procedural sedation and analgesia; Parkinson's disease; clonidine; dexmedetomidine; remifentanil
