Delimiting subterritories of the human subthalamic nucleus by means of microelectrode recordings and a hidden Markov model

Adam Zaidel*, Alexander Spivak, Lavi Shpigelman, Hagai Bergman, Zvi Israel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

97 Scopus citations


Positive therapeutic response without adverse side effects to subthalamic nucleus deep brain stimulation (STN DBS) for Parkinson's disease (PD) depends to a large extent on electrode location within the STN. The sensorimotor region of the STN (seemingly the preferred location for STN DBS) lies dorsolaterally, in a region also marked by distinct beta (13-30 Hz) oscillations in the parkinsonian state. In this study, we present a real-time method to accurately demarcate subterritories of the STN during surgery, based on microelectrode recordings (MERs) and a Hidden Markov Model (HMM). Fifty-six MER trajectories were used, obtained from 21 PD patients who underwent bilateral STN DBS implantation surgery. Root mean square (RMS) and power spectral density (PSD) of the MERs were used to train and test an HMM in identifying the dorsolateral oscillatory region (DLOR) and nonoscillatory subterritories within the STN. The HMM demarcations were compared to the decisions of a human expert. The HMM identified STN-entry, the ventral boundary of the DLOR, and STN-exit with an error of -0.09 ± 0.35, -0.27 ± 0.58, and -0.20 ± 0.33 mm, respectively (mean ± standard deviation), and with detection reliability (error < 1 mm) of 95, 86, and 91%, respectively. The HMM was successful despite a very coarse clustering method and was robust to parameter variation. Thus, using an HMM in conjunction with RMS and PSD measures of intraoperative MER can provide improved refinement of STN entry and exit in comparison with previously reported automatic methods, and introduces a novel (intra-STN) detection of a distinct DLOR-ventral boundary.

Original languageAmerican English
Pages (from-to)1785-1793
Number of pages9
JournalMovement Disorders
Issue number12
StatePublished - 15 Sep 2009


  • Beta oscillations
  • Deep brain stimulation
  • Functional neurosurgery
  • Parkinson's disease


Dive into the research topics of 'Delimiting subterritories of the human subthalamic nucleus by means of microelectrode recordings and a hidden Markov model'. Together they form a unique fingerprint.

Cite this