135 A Comparison of Outcomes Between Deep Brain Stimulation Under General Anesthesia Versus Conscious Sedation With Awake Evaluation

Alesch, François; Jain, Roshini; Chen, Lung Chi; Brücke, Thomas; Seijo, F.; Martín, Esther Suaréz San; Haegelen, Claire; Vérin, Marc; Maarouf, M.; Barbe, Michael T.; Gill, Steven; Whone, Alan; Porta, Mauro; Servello, Domenico; Timmermann, Lars

doi:10.1227/01.neu.0000489705.76089.c2

Cited by 8 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent multicenter European trial of 40 PD patients undergoing bilateral STN stimulation also found no significant difference in motor function outcomes of patients undergoing DBS with general anesthesia and those of patients who underwent DBS under conscious sedation. 1 Additionally, in a study of 14 asleep patients and 68 awake patients undergoing bilateral STN stimulation, Nakajima and colleagues 18 found no difference in the percentage improvement in postoperative OFF/ON UPDRS-III scores compared with preoperative off-medication scores between awake (50.8%) and asleep (52.8%) groups (p = 0.96). For patients who underwent the asleep DBS technique, the percentage of motor score improvement was similar to that previously reported in awake DBS studies (GPi, 28%-33%; STN, 25%-52%) 8,19 and in asleep DBS series (GPi and STN, 40%-52%).…”

Section: Primary Outcomementioning

confidence: 97%

Clinical outcomes following awake and asleep deep brain stimulation for Parkinson disease

Chen¹,

Mirzadeh²,

Chapple³

et al. 2018

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVE Recent studies have shown similar clinical outcomes between Parkinson disease (PD) patients treated with deep brain stimulation (DBS) under general anesthesia without microelectrode recording (MER), so-called "asleep" DBS, and historical cohorts undergoing "awake" DBS with MER guidance. However, few studies include internal controls. This study aims to compare clinical outcomes after globus pallidus internus (GPi) and subthalamic nucleus (STN) DBS using awake and asleep techniques at a single institution. METHODS PD patients undergoing awake or asleep bilateral GPi or STN DBS were prospectively monitored. The primary outcome measure was stimulation-induced change in motor function off medication 6 months postoperatively, measured using the Unified Parkinson's Disease Rating Scale part III (UPDRS-III). Secondary outcomes included change in quality of life, measured by the 39-item Parkinson's Disease Questionnaire (PDQ-39), change in levodopa equivalent daily dosage (LEDD), stereotactic accuracy, stimulation parameters, and adverse events. RESULTS Six-month outcome data were available for 133 patients treated over 45 months (78 GPi [16 awake, 62 asleep] and 55 STN [14 awake, 41 asleep]). UPDRS-III score improvement with stimulation did not differ between awake and asleep groups for GPi (awake, 20.8 points [38.5%]; asleep, 18.8 points [37.5%]; p = 0.45) or STN (awake, 21.6 points [40.3%]; asleep, 26.1 points [48.8%]; p = 0.20) targets. The percentage improvement in PDQ-39 and LEDD was similar for awake and asleep groups for both GPi (p = 0.80 and p = 0.54, respectively) and STN cohorts (p = 0.85 and p = 0.49, respectively). CONCLUSIONS In PD patients, bilateral GPi and STN DBS using the asleep method resulted in motor, quality-of-life, and medication reduction outcomes that were comparable to those of the awake method.

show abstract

Section: Primary Outcomementioning

confidence: 97%

Clinical outcomes following awake and asleep deep brain stimulation for Parkinson disease

Chen¹,

Mirzadeh²,

Chapple³

et al. 2018

Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…From the surgical point of view, eligible candidates for the DBS procedure should be in a satisfactory general and cognitive condition. Even though there is no difference in motor function outcomes for performing the surgery awake or under general anesthesia ( 183 ), most of the surgeries are realized with patients awake in order to perform intraoperative neurological tasks. In PD patients, concomitant disorders concerning blood clotting abnormalities, cardiovascular diseases and immune deficiencies should be evaluated.…”

Section: Clinical Aspects Of Dbs Surgerymentioning

confidence: 99%

Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease

et al. 2018

View full text Add to dashboard Cite

L-DOPA is still the most effective pharmacological therapy for the treatment of motor symptoms in Parkinson's disease (PD) almost four decades after it was first used. Deep brain stimulation (DBS) is a safe and highly effective treatment option in patients with PD. Even though a clear understanding of the mechanisms of both treatment methods is yet to be obtained, the combination of both treatments is the most effective standard evidenced-based therapy to date. Recent studies have demonstrated that DBS is a therapy option even in the early course of the disease, when first complications arise despite a rigorous adjustment of the pharmacological treatment. The unique feature of this therapeutic approach is the ability to preferentially modulate specific brain networks through the choice of stimulation site. The clinical effects have been unequivocally confirmed in recent studies; however, the impact of DBS and the supplementary effect of L-DOPA on the neuronal network are not yet fully understood. In this review, we present emerging data on the presumable mechanisms of DBS in patients with PD and discuss the pathophysiological similarities and differences in the effects of DBS in comparison to dopaminergic medication. Targeted, selective modulation of brain networks by DBS and pharmacodynamic effects of L-DOPA therapy on the central nervous system are presented. Moreover, we outline the perioperative algorithms for PD patients before and directly after the implantation of DBS electrodes and strategies for the reduction of side effects and optimization of motor and non-motor symptoms.

show abstract

“…Recent advances in intraoperative imaging have allowed targeting based on anatomy alone under general anesthesia without awake physiological and behavioral testing. Early experience with relatively small samples shows similar efficacy versus traditional awake surgery, although efficacy, adverse events, and postoperative side effects have not been compared in a prospective, randomized fashion [10,11,12,13,14,15].…”

Section: Introductionmentioning

confidence: 99%

Awake Testing during Deep Brain Stimulation Surgery Predicts Postoperative Stimulation Side Effect Thresholds

et al. 2019

View full text Add to dashboard Cite

Despite substantial experience with deep brain stimulation for movement disorders and recent interest in electrode targeting under general anesthesia, little is known about whether awake macrostimulation during electrode targeting predicts postoperative side effects from stimulation. We hypothesized that intraoperative awake macrostimulation with the newly implanted DBS lead predicts dose-limiting side effects during device activation in clinic. We reviewed 384 electrode implants for movement disorders, characterized the presence or absence of stimulus amplitude thresholds for dose-limiting DBS side effects during surgery, and measured their predictive value for side effects during device activation in clinic with odds ratios ±95% confidence intervals. We also estimated associations between voltage thresholds for side effects within participants. Intraoperative clinical response to macrostimulation led to adjustments in DBS electrode position during surgery in 37.5% of cases (31.0% adjustment of lead depth, 18.2% new trajectory, or 11.7% both). Within and across targets and disease states, dose-limiting stimulation side effects from the final electrode position in surgery predict postoperative side effects, and side effect thresholds in clinic occur at lower stimulus amplitudes versus those encountered in surgery. In conclusion, awake clinical testing during DBS targeting impacts surgical decision-making and predicts dose-limiting side effects during subsequent device activation.

show abstract

135 A Comparison of Outcomes Between Deep Brain Stimulation Under General Anesthesia Versus Conscious Sedation With Awake Evaluation

Cited by 8 publications

References 0 publications

Clinical outcomes following awake and asleep deep brain stimulation for Parkinson disease

Clinical outcomes following awake and asleep deep brain stimulation for Parkinson disease

Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease

Awake Testing during Deep Brain Stimulation Surgery Predicts Postoperative Stimulation Side Effect Thresholds

Contact Info

Product

Resources

About