Deep brain stimulation of the subthalamic nucleus for advanced Parkinson disease using general anesthesia: long-term results

Abstract

Long-term outcomes confirm that it is both safe and effective to perform STN DBS under general anesthesia. As part of patient choice, this option should be offered to all DBS candidates with advanced Parkinson disease to enable more of these patients to undergo this beneficial surgery.

Dorsolateral subthalamic neuronal activity enhanced by median nerve stimulation characterizes Parkinson’s disease during deep brain stimulation with general anesthesia

“…The findings of our study suggest that performing meticulous monitoring while administering desflurane to implant DBS electrodes in patients with PD not only allows successful electrophysiological mapping but also avoids precluding a subset of patients who are not suitable for surgery under local anesthesia. 8 The dorsolateral subterritory of the STN has long been considered an important part of the sensorimotor circuit of the basal ganglio-thalamo-cortical network and implicated as underpinning the pathophysiology of PD. 1,19 In accordance with clinical observations, high-frequency DBS within this region has also been demonstrated to achieve the best motor outcome for patients with PD and avoids the neuropsychological side effects due to current diffusion.…”

The Effects of Dexmedetomidine on Microelectrode Recordings of the Subthalamic Nucleus during Deep Brain Stimulation Surgery: A Retrospective Analysis

“…A critical limitation in our understanding of anesthetic best practices is that only a few studies have quantified the effect of anesthetics on MER [14,41,44,45], although a number have qualitatively assayed it, suggesting that too much sedation degrades the MER quality [13,14,15,20,39,41,42,43,44,46,47,48,49,50,51,52,53,54]. Considering those studies that quantified the effects on MER, we do know that some were affected by anesthetic choice, for example, during propofol sedation, background population activity within the STN, as well as FR, was reduced [13,14,41,43,44,51], REMI combined with ketamine demonstrated a reduction in background activity with preserved neuronal FRs [45], and REMI alone had no effect [41].…”

“…However, many centers avoid any sedation during this procedure because of concerns that sedation agents may affect respiration, patient arousal, symptoms, ability to cooperate during surgery, and, most relevant to this study, the MER signature itself. For example, anesthesia induced by propofol reduces the MER magnitude [13,14], which may have negative implications for the adequate identification of the STN border [15]. As the effects of different sedative agents on the MER signature and patient exam are not well characterized, the choice of anesthetic agents and the extent to which the patient is sedated remains clinically debated and varied among centers [reviewed in [16,17,18]].…”

Deep Brain Stimulation: Awake and Asleep Options

“…34 In contrast, "asleep" DBS is associated with increased patient comfort, reduced anxiety, less back pain, and fewer anesthetic concerns about respiratory difficulties. 19,35,36 In addition, since no intraoperative neurophysiologic or clinical testing is being performed there is no need to force the patient to an OFF-state; and the lack of complete levodopa reduces tremor severity, painful "off" dystonia or rigidity, "off" anxiety, and confusion for the patient.…”

“…10 Such a reduction of the duration which a patient must remain on an operating room table has been suggested to decrease the risk of venous thrombosis and pulmonary embolism. 34 In addition, shorter surgical times may be related to patient comfort factors mentioned in the previous section.…”