Intraoperative cognitive testing during deep brain stimulation surgery: A unique ethical method to obtain human task-electrophysiological data

Deep brain nuclei play essential roles in motor control, cognition, and behavior. Awake deep brain stimulation (DBS) surgery offers a unique opportunity to record neuronal activity directly from these structures in humans. However, this potential has been underutilized, as most DBS procedures focus solely on clinical targeting without leveraging the chance to explore fundamental brain functions. We developed and tested a streamlined intraoperative protocol that integrates cognitive tasks with microelectrode recordings (MER) during DBS surgery under local anesthesia. The protocol was designed to capture high-quality single-neuron activity while simultaneously assessing behavioral performance, adding minimal time or burden to the surgical workflow. In 122 patients with bilateral DBS implanted, 108 (88.52%) completed the cognitive task without adverse events. An average of 2.50 ± 1.38 neurons per patient were isolated, yielding high quality signals (mean signal‑to‑noise ratio: 1.65 ± 0.79 dB, 12951.80 ± 8959.08 spikes per neuron). The task took 26.44 ± 6.70 min on average. Patients tolerated the tasks well and no post-operative discomfort or infection experienced. These results demonstrate that brief task paradigms can be efficiently and safely implemented during DBS, providing reproducible, high-quality single-neuron data.