Five-Year Clinical Outcomes of Local versus General Anesthesia Deep Brain Stimulation for Parkinson’s Disease

Abstract

Background Studies comparing long-term outcomes between general anesthesia (GA) and local anesthesia (LA) for STN-DBS in Parkinson's disease (PD) are lacking. Whether patients who received STN-DBS in GA could get the same benefit without compromising electrophysiological recording is debated. Methods We compared five-year outcomes for different anesthetic methods (GA vs LA) during STN-DBS for PD. Thirty-six consecutive PD patients with similar preoperative characteristics, including age, disease duration, and severity, underwent the same surgical procedures except the GA (n=22) group with inhalational anesthesia and LA (n=14) with local anesthesia during microelectrode recording and intraoperative macrostimulation test. Surgical outcome evaluations included Unified Parkinson's Disease Rating Scale (UPDRS), Mini-Mental Status Examinations, and the Beck Depression Inventory. Stimulation parameters and coordinates of STN targeting were also collected. Results Both groups attained similar benefits in UPDRS part III from STN-DBS (GA 43.2 ± 14.1% vs. LA 46.8 ± 13.8% decrease, p=0.45; DBS on/Med off vs. DBS off/Med off) and no difference in reduction of levodopa equivalent doses (GA 47.56 ± 18.98% vs. LA 51.37 ± 31.73%, p=0.51) at the five-year follow-up. In terms of amplitude, frequency, and pulse width, the stimulation parameters used for DBS were comparable, and the coordinates of preoperative targeting and postoperative electrode tip were similar between two groups. There was no difference in STN recording length as well. Significantly less number of MER tracts in GA was found (p=0.04). Adverse effects were similar in both groups. Conclusions Our study confirmed that STN localization with microelectrode recording and patient comfort could be achieved based on equal effectiveness and safety of STN-DBS under GA compared with LA.

Comparison of Awake and Asleep Deep Brain Stimulation for Parkinson’s Disease: A Detailed Analysis Through Literature Review

“…They also pointed out that there was no difference in STN recording length between the two groups; however, a smaller number of MER tracts was found in GA group ( p = 0.04). The adverse effects were similar in both groups and the stimulation parameters used postoperatively for DBS were comparable in terms of amplitude, frequency, and pulse width . Very recently, some authors also performed DBS surgery under robot‐assisted technique.…”

“…For MER‐guided DBS surgeries under GA or local anesthesia (LA), there is a study comparing the long‐term outcomes (five‐year outcomes) directly between the two anesthetic methods for STN‐DBS in PD . The authors compared the outcomes of 36 consecutive PD patients with similar preoperative characteristics who underwent the same surgical procedures except the GA ( n = 22) group with inhalational anesthesia and LA ( n = 14) during microelectrode recording and intraoperative macrostimulation . They found that both groups attained similar benefits in UPDRS part III from STN‐DBS (GA 43.2 ± 14.1% vs. LA 46.8 ± 13.8% decrease, p = 0.45; DBS on/Med off vs. DBS off/Med off).…”

Bilateral Subthalamic Nucleus Deep Brain Stimulation under General Anesthesia: Literature Review and Single Center Experience

“…When the long-term outcome was investigated, the authors found that the probability of side effects by stimulation and lead revision was higher in the GA cohort without MER and test stimulation [68]. On the other hand, no difference was observed in UPDRS III score, LEDD, stimulation parameters, coordination of targeting, STN recording length, and side effects in the two groups [108].…”

The role of intraoperative microelectrode recording and stimulation in subthalamic lead placement for Parkinson’s disease

“…Intraoperative microelectrode-test-stimulation-only possible in awake procedures-mimics the postoperative stimulation situation and should hence improve optimal lead position and therefore outcome. However, retrospective patient series comparing awake and asleep procedures, the latter without the possibility of intraoperative clinical monitoring, have failed to show a clear superiority of either procedure [13][14][15][16]. A large multicenter prospective trial randomly assigning patients to either procedure has not been planned so far.…”

“…and intraoperative test stimulation and asleep procedures without intraoperative neurophysiological evaluation [13,15]. Due to limitations such as retrospective study design and a small study cohort, the results of the most previously published studies do not allow reliable conclusions to be drawn for clinical practice.…”