Menu

Electrophysiology publications

Neural recordings made with TDT systems: single units, local field potentials, EEG, ECoG and EMG.

Nature · May 2026

Neural representation of action symbols in primate frontal cortex (opens in a new tab)

Lucas Y. Tian, Kedar Garzón Gupta, Daniel J. Hanuska, … Winrich A. Freiwald

Abstract

A hallmark of intelligence is proficiency in solving new problems, including those that substantially differ from previously seen problems. Problem solving in turn depends on the goal-directed generation of novel ideas and behaviours 1 , which has been proposed to involve internal representations of discrete units (or symbols) that can be recombined into numerous possible composite representations 1–7 . Although this view has been influential in cognitive-level explanations of behaviour, definitive evidence for a neuronal substrate of symbols has remained elusive. Here we identify a neural population that encodes action symbols—recombinable representations of discrete units of motor behaviour—in a specific area of the frontal cortex. In macaque monkeys performing a drawing-like task, we found behavioural evidence that action elements (strokes) exhibit three crucial features that indicate an underlying symbolic representation: (1) invariance over low-level motor parameters; (2) categorical structure, which reflects discrete action types; and (3) recombination into novel sequences. Based on simultaneous neural recordings across eight regions of the motor, premotor and prefrontal cortex, we identified population activity specifically in the ventral premotor cortex that encodes planned actions in a manner that also reflects invariance, categorical structure and recombination. These findings reveal a neural representation of action symbols localized to the ventral premotor cortex and a putative neural substrate for symbolic operations.

bioRxiv · Feb 2026

Shared somatosensory-motor neural population dynamics track motor recovery after stroke (opens in a new tab)

Ian S. Heimbuch, Preeya Khanna, Lisa Novik, … Karunesh Ganguly

Abstract

S ummary Although somatosensation is known to be important for precise hand control, how coordinated activity across sensory and motor cortical areas supports hand movements and object interactions is unclear. We simultaneously recorded neural activity from dorsal premotor cortex (PMd) and Area 2 of the primary somatosensory cortex in three rhesus macaques performing a reach-to-grasp task during recovery from a primary motor cortex (M1) lesion. Using dual-area latent factor analysis, we decomposed population activity into cross-area factors (CFs) shared between PMd and Area 2 and within-area factors (WFs) local to each region. Shared CFs tracked hand kinematics closely despite explaining less overall variance. Strikingly, the emergence of long-timescale, stereotyped sensory–motor cross-area dynamics was correlated with recovery of prehension and object grasping, whereas changes in within-area dynamics were not correlated with recovery. These findings suggest that restoration of coordinated sensory–motor population dynamics is important for recovery of skilled hand function after injury.

bioRxiv · Jan 2026

Neural representation of action grammar structure in primate frontal cortex (opens in a new tab)

Lucas Y. Tian, Daniel J. Hanuska, Kedar Garzón Gupta, … Winrich A. Freiwald

Abstract

Humans and other animals can solve new problems, even on the first attempt. This capacity to generate novel problem-solving behavior has been hypothesized to depend on brain mechanisms for recombining units of knowledge using systems of procedural rules, or grammars . Yet, whether and how the brain represents and implements grammars remains unclear, in large part due to the lack of neural recordings (typically performed in animal models) during grammar-based problem solving (typically studied in humans). Here, we address that gap, and in turn identify an underlying neural basis of grammatical behavior. We designed a visual–motor construction task in which macaque monkeys trace complex, often novel, geometric figures by generating a sequence of strokes, each a distinct shape, like a circle, dash, or chevron (action symbols 1 ). Critically, sequencing was guided by a learned hierarchical action grammar A n B m C k , meaning “repeat shape A, then repeat shape B, then repeat shape C”, where the number of repetitions (n, m, and k) varied across problems. Behavior was internally generated (no cues guiding stroke order), problem-directed (to construct a specific image), and exhibited zero-shot generalization (successful on the first trial for novel problems, including harder ones)--key hallmarks of grammar use. To identify underlying neural substrates, we recorded from multiple frontal cortical areas previously implicated in rule use or action sequencing. Activity during drawing encoded key structural properties of the action grammar: (i) shape index (A, B, C), (ii) abstract role (e.g., the role A independent of the specific shape), and (iii) ordinal position within a shape repeat. Moreover, all three properties were strongest in a single region, the pre-supplementary motor area (preSMA). We suggest the possibility that this conjunction of representations is a signature of an implementation of an iterative algorithm resembling a “for-loop” program: internally tracking how many repetitions remain for each shape index and switching to the next when complete. Our study establishes a paradigm for studying the neural basis of grammar-guided novel behavior and identifies in preSMA a dynamic representation of grammatical structure supporting such behavior.

Neuron · 2026

Cortical PV interneurons regulate loudness perception and sustainably reverse loudness hypersensitivity (opens in a new tab)

Kameron K. Clayton, Bshara Awwad, Matthew McGill, … Daniel B. Polley

Abstract

Parvalbumin-expressing inhibitory neurons (PVNs) stabilize cortical network activity, generate gamma rhythms, and regulate experience-dependent plasticity. We found that PVNs act like a volume knob in the mouse auditory cortex (ACtx), bi-directionally adjusting neural and perceptual sensitivity to sound level over a 20 dB range. PVN-based gain adjustments were "sticky," such that a single bout of PVN activation at 40 Hz-but not at 1 or 70 Hz-sustainably dampened ACtx sound responsiveness, enhanced feedforward inhibition, and behaviorally desensitized mice to loudness. We then developed a mouse model of adult-onset hyperacusis by demonstrating ACtx hyperactivity, PVN hypofunction, and loudness hypersensitivity following a restricted noise-induced cochlear lesion. We found that several minutes of 40-Hz PVN stimulation in noise-exposed mice sustainably dampened ACtx hyperactivity and restored normal loudness sensitivity for 1 week. These findings demonstrate that sensory disorders caused by permanent peripheral injuries can be reversed by patterned stimulation of cortical circuits that directly regulate perception.

Cerebral Cortex · 2026

Layer 6 is a hub for cholinergic modulation in the mouse auditory cortex (opens in a new tab)

Lucas G Vattino, Kameron K Clayton, Troy A Hackett, … Anne E Takesian

Abstract

Basal forebrain cholinergic neurons (BFCNs) densely innervate auditory cortex (ACtx), conveying signals linked to internal brain states and external sensory cues. Acetylcholine (ACh) is known to rapidly modulate cortical circuits through nicotinic ACh receptor (nAChR)-mediated activation of layer 1 inhibitory neurons (L1-INs). However, BFCN terminals are also abundant in deeper layers, where their functional impact has received less attention. Using multi-plex in situ labeling across cortical layers and cell types, we found that layer 6 pyramidal neurons (L6-PNs) are highly enriched in diverse transcripts for nAChR subunits and muscarinic ACh receptors (mAChRs). In vivo optogenetic activation of BFCN axons revealed persistent modulation of regular spiking units in L2-6 but a rapid phasic activation only in L6. In acute slices, optogenetic activation of BFCN axons elicited fast nAChR-mediated excitatory post-synaptic potentials in L6-PNs, comparable to responses in L1-INs, and slower mAChR-mediated inhibitory responses. These findings identify L1-INs and excitatory L6-PNs as two major hubs for BFCN modulation of cortical circuits. By recruiting distinct receptor mechanisms and circuit motifs in L1 and L6, BFCNs may engage parallel pathways of cholinergic control that couple fast, transient modulation with slower, sustained regulation to shape cortical perception and plasticity.

Dystonia · Nov 2025

Behaviorally coupled oscillations reveal distinct timing roles of basal ganglia and cerebellothalamic circuits in dystonia (opens in a new tab)

S. Alireza Seyyed Mousavi, Sina Javadzadeh, Mehrnaz Asadi, … Terence D. Sanger

Abstract

As part of a deep brain stimulation (DBS) procedure, direct electrophysiological recordings from thalamic and basal ganglia circuits were obtained from a pediatric participant with secondary dystonia to examine the neural mechanisms of motor timing. The participant performed a two-phase repetitive timing task that began with synchronization to a series of externally presented auditory cues, followed by a continuation phase in which the participant maintained the movement rhythm without external guidance. Simultaneous recordings from stereoelectroencephalography (sEEG) leads implanted in the globus pallidus internus (GPi), subthalamic nucleus (STN), ventral oralis (Vo), centromedian nucleus (CM), and thalamic nuclei receiving projections from the cerebellum (ventral intermediate nucleus (VIM) and centrolateral nucleus (CL)) revealed behaviorally relevant neural dynamics. Local field potentials (LFPs) from recorded nuclei exhibited strong, time-locked responses during the synchronization phase, with reduced amplitudes during the continuation phase. Time-frequency analysis showed consistent power increases around the corresponding mean of the inter-response intervals (IRIs) in both behavioral output and neural signals, suggesting frequency-specific entrainment across circuits. These findings suggest of cerebellar-thalamic and basal ganglia contributions to temporal coordination.

The Journal of Physiology · Jul 2025

State-dependent neural representations of muscle synergies in the spinal cord revealed by optogenetic stimulation (opens in a new tab)

Borong He, Paola Salmas, Jing Zhang, … Vincent C. K. Cheung

Abstract

The central nervous system controls movement by combining neuromotor modules, known as muscle synergies. Previous studies suggest that spinal premotor interneurons (PreM‐INs) contribute to the encoding of stable muscle synergies for voluntary movement. But descending and sensory inputs also influence motor outputs through the spinal interneuronal network, which may be configured by its inputs to encode different sets of muscle synergies depending on the network state, thereby recruiting different selections of synergies. Here we tested this possibility of state‐dependent synergy encoding by examining the muscle synergies represented by the same upstream spinal interneurons under different activity states induced by various optogenetic stimulation patterns. Lumbosacral spinal units and electromyographic (EMG) activities of hindlimb muscles were simultaneously recorded from anaesthetized Thy1‐ChR2 mice as the spinal cord was stimulated by one or two optic fibres at different intensities. The synergy encoded by each unit was revealed as a ‘muscle field’ derived from spike‐triggered averages of EMG, whereas the entire muscle synergy set was factorized from the EMG. We found that although the muscle synergy set remained stable across stimulation conditions, the muscle fields of the same units were matched to different synergies within the set in different states. Thus the interneurons may flexibly adjust their connectivity with the motoneurons of the muscles as descending and sensory afferents impose different states on the spinal network. State‐dependent encoding of muscle synergies may allow different synergies to be selected for producing stable movement in an ever‐changing workspace environment. image Key points Muscle synergies for locomotion can be represented by spinal interneurons, as revealed by the interneurons’ muscle fields derived from spike‐triggered averages of EMG. The muscle field of a single spinal interneuron may vary under different stimulation conditions, as demonstrated by optogenetic stimulation. Encoding of muscle synergies is dependent on the state of spinal activities, thus facilitating the selection of appropriate synergies in different dynamic environments.

Frontiers in Neuroscience · Jul 2025

Deep brain stimulation in globus pallidus internus travels to thalamus and subthalamic nuclei along physiological pathways (opens in a new tab)

Maral Kasiri, Jessica Vidmark, Estefania Hernandez-Martin, … Terence D. Sanger

Abstract

Introduction Deep brain stimulation (DBS) is a neuromodulation method for treatment of various neurological disorders. Research on DBS has often focused on local inhibition or excitation effects, at the site of stimulation. However, it is well-known that DBS can lead to robust evoked potentials (EP) not only at the stimulation site, representing the local effect, but also in distant brain regions, representing the effects on distant targets. While the significance of these EPs for therapeutic outcomes is not known, it appears that the electrical effects of DBS have a partial modulatory impact on downstream targets. Nonetheless, it partly remains unclear through what mechanism DBS pulses travel to the distant targets or what portion of the pulses travel along the normal pathways from the stimulation site. The possible scenarios include orthodromic or antidromic pathways, accessory pathways, normally inhibited pathways, and direct electromagnetic activation of distant sites. We hypothesize that the pathways that transmit DBS pulses include the pathways that transmit intrinsic neural signals. Methods To test this, we performed a transfer function analysis on deep brain recordings from children with dystonia, during DBS-off condition and compared its impulse response with the transmission of signals from electrical stimulation during DBS-on condition. We compared impulse responses derived from intrinsic neural signals during voluntary movement (DBS-off) to evoked potentials (EPs) recorded during electrical stimulation (DBS-on), focusing on directional transmission (orthodromic vs. antidromic). Results DBS EPs were more accurately predicted by impulse responses corresponding to direct axonal activation rather than somatic relay. Significant correlations between intrinsic signal transfer functions and EPs, particularly in orthodromic directions ( p -value < 0.01) from pallidum to thalamus and subthalamic nucleus, support our hypothesis that DBS travels along physiological pathways. Discussion These results suggest that DBS engages existing motor pathways to reach distant targets, offering mechanistic insight into its network effects. This supports future approaches that could tailor treatment plans based on individual connectivity maps to improve clinical efficacy of DBS.

Brain Communications · 2025

Local field potential signal transmission is correlated with the fractional anisotropy measured by diffusion tractography (opens in a new tab)

Maral Kasiri, Sumiko Abe, Rahil Soroushmojdehi, … Terence D Sanger

Abstract

In this paper we aim to examine the correlation between diffusion tensor imaging parameters of anatomical connectivity and characteristics of signal transmission obtained from patient-specific transfer function models. Here, we focused on elucidating the correlation between structural and functional neural connectivity within a cohort of pediatric patients diagnosed with dystonia. Diffusion tractography images were obtained from 12 patients with dystonia prior to the deep brain stimulation surgery. For each patient, we processed the imaging data to estimate anatomical measures including fractional anisotropy, axial diffusivity, number of fibre tracts per unit area, and fibre tract length. After the implantation of temporary depth leads for each patient as part of their treatment plan, intracranial signals were recorded. Transfer function models of local field potential recordings and the corresponding measures of functional connectivity were computed for each patient. Linear mixed effect analysis was then employed to determine the relationship between transfer function measures and diffusion tractography parameters. Our results illustrate a positive correlation between fractional anisotropy, AD, and intrinsic neural transmission measures, representing amplification and spread of intrinsic neural oscillations, obtained from the transfer functions models. However, no significant correlation was found between the functional connectivity and number of fibre tracts or fibre lengths. Our findings suggest that white matter integrity, as measured by fractional anisotropy and AD, can potentially reflect the amplification and spread of intrinsic brain signals throughout the network. This study underscores the significant relationship between structural and functional connectivity, offering valuable insights into propagation of neural activity in the brain network and potential implications for optimizing non-invasive treatments and planning for neurological disorders.

medRxiv · Apr 2024

Diffusion tractography predicts Deep Brain Stimulation evoked potential amplitude and delay (opens in a new tab)

Sumiko Abe, Jessica Vidmark, Estefania Hernandez-Martin, … Terence D. Sanger

Abstract

Objective This study investigated the relationship between DBS evoked potentials (EPs) and diffusion tensor imaging (DTI) in a group of patients with dystonia who underwent DBS treatment. EPs and DTI are both useful methods for studying neural connectivity in the brain but measure different aspects of brain function. EPs provide information on electrical connectivity, while DTI provides information on anatomical pathways connecting regions. Methods This study focused on the pallidum and motor thalamus nuclei, which are common targets for DBS in dystonia. Prior to DBS implantation, DTI images were acquired for each patient, and were processed to obtain DTI coefficients such as length (L), volume (V), and fractional anisotropy (FA) of the fiber tracts. The relationship between the fiber tracts and electrophysiology was examined using a generalized linear model (GLM). Results We showed that the amplitude of EPs correlated with FA and tract volume, while delay correlated with tract length. These findings suggest that DBS signals travel across tracts to affect both local and distant brain regions, and the magnitude of the effect of DBS is determined by the integrity of the white matter tract, while DBS signal delay is affected by the tract length. Our results further suggest that the magnitude and delay of the spread of the DBS signal may be predicted by the DTI connectivity. This provides strong supporting evidence for other studies that have assumed, but have been unable to test, such a relationship. Conclusion Overall, this study suggests that the electrical effects of DBS can be at least partially predicted by noninvasive DTI imaging in patients with dystonia. By combining EPs with DTI, we could investigate the propagation of stimulation pulses through brain regions. While this relationship has been previously hypothesized by the neuroscience community, this is the first study in humans to demonstrate this relationship between DBS EPs and DTI, thereby advancing the field of human brain mapping and enhancing the precision of neurosurgical targeting.

Science Advances · Mar 2023

Progressive neuronal plasticity in primate visual cortex during stimulus familiarization (opens in a new tab)

Kenji W. Koyano, Elena M. Esch, Julie J. Hong, … David A. Leopold

Abstract

The primate brain is equipped to learn and remember newly encountered visual stimuli such as faces and objects. In the macaque inferior temporal (IT) cortex, neurons mark the familiarity of a visual stimulus through response modification, often involving a decrease in spiking rate. Here, we investigate the emergence of this neural plasticity by longitudinally tracking IT neurons during several weeks of familiarization with face images. We found that most neurons in the anterior medial (AM) face patch exhibited a gradual decline in their late-phase visual responses to multiple stimuli. Individual neurons varied from days to weeks in their rates of plasticity, with time constants determined by the number of days of exposure rather than the cumulative number of presentations. We postulate that the sequential recruitment of neurons with experience-modified responses may provide an internal and graded measure of familiarity strength, which is a key mnemonic component of visual recognition.

Nature Communications · Sep 2022

Local features drive identity responses in macaque anterior face patches (opens in a new tab)

Elena N. Waidmann, Kenji W. Koyano, Julie J. Hong, … David A. Leopold

Abstract

Humans and other primates recognize one another in part based on unique structural details of the face, including both local features and their spatial configuration within the head and body. Visual analysis of the face is supported by specialized regions of the primate cerebral cortex, which in macaques are commonly known as face patches. Here we ask whether the responses of neurons in anterior face patches, thought to encode face identity, are more strongly driven by local or holistic facial structure. We created stimuli consisting of recombinant photorealistic images of macaques, where we interchanged the eyes, mouth, head, and body between individuals. Unexpectedly, neurons in the anterior medial (AM) and anterior fundus (AF) face patches were predominantly tuned to local facial features, with minimal neural selectivity for feature combinations. These findings indicate that the high-level structural encoding of face identity rests upon populations of neurons specialized for local features.

Cell Reports · Dec 2021

Stimulus-specific plasticity of macaque V1 spike rates and gamma (opens in a new tab)

Alina Peter, Benjamin Johannes Stauch, Katharine Shapcott, … Pascal Fries

Abstract

When a visual stimulus is repeated, average neuronal responses typically decrease, yet they might maintain or even increase their impact through increased synchronization. Previous work has found that many repetitions of a grating lead to increasing gamma-band synchronization. Here, we show in awake macaque area V1 that both repetition-related reductions in firing rate and increases in gamma are specific to the repeated stimulus. These effects show some persistence on the timescale of minutes. Gamma increases are specific to the presented stimulus location. Further, repetition effects on gamma and on firing rates generalize to images of natural objects. These findings support the notion that gamma-band synchronization subserves the adaptive processing of repeated stimulus encounters.

Brain Sciences · Nov 2021

Transient Complete Resolution of Tourette Syndrome Symptoms Following Personalized Depth Electrode Placement (opens in a new tab)

Jennifer A. MacLean, Diana Ferman, Jason K. Chu, … Terence D. Sanger

Abstract

Treatment refractory Tourette syndrome has been shown to be improved with deep brain stimulation, but with multiple possible stimulation locations and variable and incomplete benefit. This study presents a single case of complete amelioration of motor and verbal tics in a patient with Tourette syndrome during placement of 12 stereo-EEG electrodes to identify optimal targets for permanent stimulating electrodes. Subsequently, substantial improvement in motor and verbal tic frequency occurred with placement and programming of permanent electrodes in bilateral globus pallidus internus and nucleus accumbens, but without the complete resolution seen during depth electrode placement. We suggest that simultaneous stimulation at multiple patient-specific targets could provide effective control of Tourette symptomatology, but further study will be needed.

Frontiers in Neural Circuits · Aug 2020

Interactions Between Motor Thalamic Field Potentials and Single-Unit Spiking Are Correlated With Behavior in Rats (opens in a new tab)

Matt Gaidica, Amy Hurst, Christopher Cyr, Daniel K. Leventhal

Abstract

Field potential (FP) oscillations are believed to coordinate brain activity over large spatiotemporal scales, with specific features (e.g., phase and power) in discrete frequency bands correlated with motor output. Furthermore, complex correlations between oscillations in distinct frequency bands (phase-amplitude, amplitude-amplitude, and phase-phase coupling) are commonly observed. However, the mechanisms underlying FP-behavior correlations and cross-frequency coupling remain unknown. The thalamus plays a central role in generating many circuit-level neural oscillations, and single-unit activity in motor thalamus (Mthal) is correlated with behavioral output. We, therefore, hypothesized that motor thalamic spiking coordinates motor system FPs and underlies FP-behavior correlations. To investigate this possibility, we recorded wideband motor thalamic (Mthal) electrophysiology as healthy rats performed a two-alternative forced-choice task. Delta (1-4 Hz), beta (13-30 Hz), low gamma (30-70 Hz), and high gamma (70-200 Hz) power were strongly modulated by task performance. As in the cortex, the delta phase was correlated with beta/low gamma power and reaction time. Most interestingly, subpopulations of Mthal neurons defined by their relationship to the behavior exhibited distinct relationships with FP features. Specifically, neurons whose activity was correlated with action selection and movement speed were entrained to delta oscillations. Furthermore, changes in their activity anticipated power fluctuations in beta/low gamma bands. These complex relationships suggest mechanisms for commonly observed FP-FP and spike-FP correlations, as well as subcortical influences on motor output.

bioRxiv · Sep 2019

Delayed suppression normalizes face identity responses in the primate brain (opens in a new tab)

Kenji W. Koyano, Adam P. Jones, David B. T. McMahon, … David A. Leopold

Abstract

The primate brain is specialized for social visual perception. Previous work indicates that recognition draws upon an internal comparison between a viewed face and an internally stored average face. Here we demonstrate that this comparison takes the form of a delayed, dynamic suppression of face averageness among single neurons. In three macaque face patches, spiking responses to low-identity morphed faces met with a synchronous attenuation starting approximately 200 ms after onset. Analysis showed that a late-emerging V-shaped identity tuning was sometimes superimposed on linear ramp tuning. This pattern could not be ascribed to repetition suppression within a given session. The results indicate that the brain’s analysis of faces is enhanced through predictive normalization of identity, which increases sensitivity among face-selective neurons to distinctive facial features known to drive recognition.

bioRxiv · Aug 2018

An Automated Behavioral Apparatus to Assess Distal Forelimb Function in Non-Human Primates (opens in a new tab)

Douglas Totten, Lisa Novik, Kari Christe, … Karunesh Ganguly

Abstract

Background Primate distal forelimb behaviors are commonly assessed using reach-to-grasp tasks. While these tasks are widely recognized as sensitive assays for forelimb function, they often require experimenter input, lack precise temporal cues for physiological monitoring, and can be expensive. New Method Using components developed by open-source electronics platforms, we have designed and tested a low-cost system to measure distal forelimb function in non-human primates. Our system is inexpensive; it is made primarily of acrylic and 3D printed plastic parts. Our control software, developed in MATLAB, was also used to control two cameras in order to capture and process video during behavior. The system was equipped with sensors, motors and microcontrollers to control the timing of the task and facilitate synchronization between behavior and neurophysiology with high temporal precision. Results We demonstrate that this system can be used to monitor motor recovery after stroke and investigate neurophysiological correlates of motor control. Comparison with Existing Methods Compared to a previous version of this task, our setup reduces experimenter input while providing unbiased delivery of behavioral cues and behavioral measurements with the temporal precision necessary for electrophysiological studies. Conclusions In summary, our system will allow unbiased monitoring of forelimb function in both healthy and injured animals that is compatible with electrophysiological studies.

Brain Sciences · Jul 2018

Pediatric Deep Brain Stimulation Using Awake Recording and Stimulation for Target Selection in an Inpatient Neuromodulation Monitoring Unit (opens in a new tab)

Terence D. Sanger, Mark Liker, Enrique Arguelles, … Aaron Robison

Abstract

Deep brain stimulation (DBS) for secondary (acquired, combined) dystonia does not reach the high degree of efficacy achieved in primary (genetic, isolated) dystonia. We hypothesize that this may be due to variability in the underlying injury, so that different children may require placement of electrodes in different regions of basal ganglia and thalamus. We describe a new targeting procedure in which temporary depth electrodes are placed at multiple possible targets in basal ganglia and thalamus, and probing for efficacy is performed using test stimulation and recording while children remain for one week in an inpatient Neuromodulation Monitoring Unit (NMU). Nine Children with severe secondary dystonia underwent the NMU targeting procedure. In all cases, 4 electrodes were implanted. We compared the results to 6 children who had previously had 4 electrodes implanted using standard intraoperative microelectrode targeting techniques. Results showed a significant benefit, with 80% of children with NMU targeting achieving greater than 5-point improvement on the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), compared with 50% of children using intraoperative targeting. NMU targeting improved BFMDRS by an average of 17.1 whereas intraoperative targeting improved by an average of 10.3. These preliminary results support the use of test stimulation and recording in a Neuromodulation Monitoring Unit (NMU) as a new technique with the potential to improve outcomes following DBS in children with secondary (acquired) dystonia. A larger sample size will be needed to confirm these results.