Intraoperative clinical testing overestimates the therapeutic window of the permanent DBS electrode in the subthalamic nucleus

Blume, Josefine; Schlaier, J.; Rothenfusser, Eva; Anthofer, Judith; Zeman, Florian; Brawanski, Alexander; Bogdahn, Ulrich; Lange, Max

doi:10.1007/s00701-017-3255-4

Cited by 15 publications

(8 citation statements)

References 25 publications

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“…The significant differences highlight the fact that intraoperative testing and predictions overestimate the therapeutic window both for upper and lower limits. Those results mostly explained by the microlesion effect and stressful testing conditions are in line with previous studies [16,40]. Clinicians should anticipate this overestimation with intraoperative testing or intraoperative predictions.…”

Section: Discussionsupporting

confidence: 76%

Data-Driven Prediction of the Therapeutic Window during Subthalamic Deep Brain Stimulation Surgery

Baumgarten

Haegelen

Zhao

et al. 2018

Stereotact Funct Neurosurg

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Background: Moving from awake surgery under local anesthesia to asleep surgery under general anesthesia will require to precisely predict the outcome of deep brain stimulation. Objective: To propose a data-driven prediction of both the therapeutic effect and side effects of the surgery. Methods: The retrospective intraoperative data from 30 patients operated on in the subthalamic nucleus were used to train an artificial neural network to predict the deep brain stimulation outcome. A leave-one-out validation was undertaken to give a predictive performance that would reflect the performance of the predictive model in clinical practice. Three-dimensional coordinates and the amount of current of the electrodes were used to train the model. Results: 130 electrode positions were reviewed. The areas under the curve were 0.902 and 0.89 for therapeutic and side effects, respectively. The mean sensitivity and specificity were 93.07% (SD 0.95) and 69.24% (SD 5.27) for the therapeutic effect, 73.47% (SD 10.55) and 91.82% (SD 0.12) for the side effect. Conclusion: Data-driven prediction could be an additional modality to predict deep brain stimulation outcome. Further validation is needed to precisely use this method for performing surgery under general anesthesia.

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Section: Discussionsupporting

confidence: 76%

Data-Driven Prediction of the Therapeutic Window during Subthalamic Deep Brain Stimulation Surgery

Baumgarten

Haegelen

Zhao

et al. 2018

Stereotact Funct Neurosurg

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“…Since the advent of DBS surgery, lead placement in an awake state has become the standard procedure. The location and depth of electrode implantation are determined by iMER and temporary stimulation tests to minimize the adverse effects of stimulation ( Blume et al, 2017 ; Mehanna et al, 2017 ; Walker et al, 2019 ; Frequin et al, 2020 ). However, lead placement under GA is a better option for some PD patients with severe off-medication symptoms and anxiety.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Different Anesthesia Methods on the Treatment of Parkinson’s Disease by Bilateral Deep Brain Stimulation of the Subthalamic Nucleus

Lü

Chang

et al. 2022

Front. Neurosci.

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BackgroundSubthalamic nucleus deep brain stimulation (STN–DBS) surgery for Parkinson’s disease (PD) is routinely performed at medical centers worldwide. However, it is debated whether general anesthesia (GA) or traditional local anesthetic (LA) is superior.PurposeThis study aims to compare the effects of LA and GA operation methods on clinical improvement in patients with PD, such as motor and non-motor symptoms, after STN–DBS surgery at our center.MethodA total of 157 patients with PD were retrospectively identified as having undergone surgery under LA (n = 81) or GA (n = 76) states. In this study, the Unified Parkinson’s Disease Rating Scale Motor Score (UPDRS-III) in three states, levodopa-equivalent-daily-dose (LEDD), surgical duration, intraoperative microelectrode recording (iMER) signal length, postoperative intracranial volume, electrode implantation error, neuropsychological function, quality of life scores, and complication rates were collected and compared. All patients with PD were routinely followed up at 6, 12, 18, and 24 months postoperatively.ResultOverall improvement in UPDRS-III was demonstrated at postoperative follow-up, and there was no significant difference between the two groups in medication-off, stimulation-off state and medication-off, stimulation-on state. However, UPDRS-III scores in medication-on, stimulation-on state under GA was significantly lower than that in the LA group. During postoperative follow-up, LEDD in the LA group (6, 12, 18, and 24 months, postoperatively) was significantly lower than in the GA group. However, there were no significant differences at baseline or 1-month between the two groups. The GA group had a shorter surgical duration, lower intracranial volume, and longer iMER signal length than the LA group. However, there was no significant group difference in electrode implantation accuracy and complication rates. Additionally, the Hamilton Anxiety Scale (HAMA) was significantly lower in the GA group than the LA group at 1-month follow-up, but this difference disappeared at longer follow-up. Besides, there was no significant group difference in the 39-item Parkinson’s Disease Questionnaire (PDQ-39) scale scores.ConclusionAlthough both groups showed overall motor function improvement without a significant postoperative difference, the GA group seemed superior in surgical duration, intracranial volume, and iMER signal length. As the accuracy of electrode implantation can be ensured by iMER monitoring, DBS with GA will become more widely accepted.

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“…One has to take into account, that adequate clinical evaluation of slight changes of muscle tone, oculomotor function or speech like the differentiation between PD associated dysarthria and DBS-induced dysarthria in the operation room setting with the patient off medication for more than 12 hours can be challenging even for an experienced neurologist specialized for clinical monitoring of DBS surgery (28). Finally, the mere fact that the patient undergoes clinical testing in the awake state can already lead to placebo effects leading to better intraoperative clinical outcome that may not be confirmed postoperatively (29,30).…”

Section: Discussionmentioning

confidence: 99%

Asleep Surgery May Improve the Therapeutic Window for Deep Brain Stimulation of the Subthalamic Nucleus

Senemmar

Hartmann

Slotty

et al. 2021

Neuromodulation: Technology at the Neural Interface

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Objective The effect of anesthesia type in terms of asleep vs. awake deep brain stimulation (DBS) surgery on therapeutic window (TW) has not been investigated so far. The objective of the study was to investigate whether asleep DBS surgery of the subthalamic nucleus (STN) improves TW for both directional (dDBS) and omnidirectional (oDBS) stimulation in a large single‐center population. Materials and Methods A total of 104 consecutive patients with Parkinson's disease (PD) undergoing STN‐DBS surgery (80 asleep and 24 awake) were compared regarding TW, therapeutic threshold, side effect threshold, improvement of Unified PD Rating Scale motor score (UPDRS‐III) and degree of levodopa equivalent daily dose (LEDD) reduction. Results Asleep DBS surgery led to significantly wider TW compared to awake surgery for both dDBS and oDBS. However, dDBS further increased TW compared to oDBS in the asleep group only and not in the awake group. Clinical efficacy in terms of UPDRS‐III improvement and LEDD reduction did not differ between groups. Conclusions Our study provides first evidence for improvement of therapeutic window by asleep surgery compared to awake surgery, which can be strengthened further by dDBS. These results support the notion of preferring asleep over awake surgery but needs to be confirmed by prospective trials.

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Intraoperative clinical testing overestimates the therapeutic window of the permanent DBS electrode in the subthalamic nucleus

Cited by 15 publications

References 25 publications

Data-Driven Prediction of the Therapeutic Window during Subthalamic Deep Brain Stimulation Surgery

Data-Driven Prediction of the Therapeutic Window during Subthalamic Deep Brain Stimulation Surgery

The Effects of Different Anesthesia Methods on the Treatment of Parkinson’s Disease by Bilateral Deep Brain Stimulation of the Subthalamic Nucleus

Asleep Surgery May Improve the Therapeutic Window for Deep Brain Stimulation of the Subthalamic Nucleus

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