Detection Analysis of Perioperative Plasma and CSF Reveals Risk Biomarkers of Postoperative Delirium of Parkinson’s Disease Patients Undergoing Deep Brain Stimulation of the Subthalamic Nuclei

Abstract

Objective This study aimed to explore possible biomarkers of postoperative delirium (POD) of Parkinson’s disease (PD) patients received deep brain stimulation (DBS) of the subthalamic nuclei. Materials and methods This nested case control study analyzed perioperative plasma and cerebral spinal fluid (CSF) of patients (n = 40) who developed POD undergone DBS surgery (n = 10) and those who did not (n = 30). Blood sample was collected before surgery and on the first day postoperative, CSF sample was collected at the beginning of the operation. POD was assessed by the Confusion Assessment Method (CAM) twice a day between 7:00 am and 7:00 pm after the surgery until discharge. Plasma and CSF sample from the two groups were analyzed to investigate possible biomarkers for POD in PD patients. Results There was no difference between POD and Non-POD groups on the concentration of Interleukin 6 and Tumor Necrosis Factor-α in CSF, preoperative plasma and postoperative plasma. There was no difference between POD and Non-POD groups on the concentration of S100 calcium-binding protein β protein (S100β) and Neurofilament light chain (NFL) in preoperative plasma and postoperative plasma. The concentration of C-reactive protein (CRP), NFL and S100β were significant higher in POD group than non-POD group in CSF. The concentration of CRP was significantly higher in POD group than non-POD group in preoperative plasma and postoperative plasma. CSF concentration of S100β might be a potential biomarker for POD via the receiver operating characteristic curve analysis and the area under the curve value of 0.973. Conclusion For PD patients received DBS surgery, CSF S100β might be a marker for aiding detection of high-risk patients with delirium. This requires further confirmation in clinical trials.

Evolution of Deep Brain Stimulation Techniques for Complication Mitigation

“…65 Given this constellation of risk factors, groups began developing nomograms and screening tools to estimate the risk of postoperative delirium. 66-69 In the unfortunate event of a patient developing POC, conservative management and early reinitiation of anti-Parkinsonian medications remain the hallmark of therapy. 37,70…”

“…Microelectrode recording [45][46][47][48][49] Avoidance of sulci 50 Transventricular approaches 45,50,54 Hypertension 50,55,56 Blood thinners [57][58][59][60] Postoperative confusion Risk factor identification [61][62][63][64][65][66][67][68][69] OR time reduction 84,[122][123][124] Lead inaccuracies Cerebrospinal fluid loss [71][72][73][74] Skull-mounted frames [83][84][85][86][87][88][89][90][91][92][93][94] Robotics [95][96][97][98][99]…”

“…65 Given this constellation of risk factors, groups began developing nomograms and screening tools to estimate the risk of postoperative delirium. [66][67][68][69] In the unfortunate event of a patient developing POC, conservative management and early reinitiation of anti-Parkinsonian medications remain the hallmark of therapy. 37,70 Techniques to Reduce Inaccuracy Intraoperative techniques that prevent cerebrospinal fluid (CSF) loss/egress and improved imaging modalities have improved lead placement.…”