MRI-verified “asleep” deep brain stimulation in Malta through cross border collaboration: clinical outcome of the first five years

Abstract

An MRI-guided and MRI-verified approach to DBS was successfully implemented through cross border collaboration with achievement of expected clinical results. This healthcare collaboration developed out of necessity and opportunity, taking advantage of a UK-based neurosurgeon from Malta. The UK healthcare system benefits from numerous immigrants at Consultant level. Such a mutually beneficial arrangement could enable such individuals to offer their expertise to citizens in the UK as well as their country of origin.

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

“…In this study, a reduction in dyskinesia duration (p < 0.001), disability (p = 0.009) and off period duration, and improvement of sleep disorders were observed. Other authors also reported significant improvement in off-medication UPDRS, levodopa-equivalent daily dose (LEDD), and quality of life [29,35]. Harries et al reported a long-term clinical outcome of more than 5 years [49].…”

“…Successful clinical results on the intraoperative imaging to verify the accuracy of STN lead position instead of electrophysiological structure mapping or stimulation tests during DBS surgery have been reported [23,29,31,37,[40][41][42][43][44]. In recent studies on the advancement of intraoperative imaging, no significant clinical results were found when compared to awake DBS [16,30,37,45,46].…”

“…Other centers use intraoperative (interventional) MRI (iMRI) to guide DBS electrode placement to the STN (Table 1) [23][24][25][26][27][28][29]44,[62][63][64]. For example, the UCSF group reported their experience about bilateral STN DBS in PD patients using a first-generation MRI system (Nexframe, high-field interventional MR-imaging) [25] and ClearPoint system (ClearPoint interventional MRI) [27].…”

“…Due to the improved image quality of preoperative imaging, determining the final electrode location by imaging alone without MER does not negatively affect motor improvement and LEDD, and does not aggravate surgical complications [24,26,29,42,87]. The UPDRS III reduction rate at postoperative 3 months was higher in the group of STN DBS under LA with MER cohort (p = 0.006), but there was no significant difference at 1 year (p = 0.18), as well as in dysarthria, capsular, oculomotor, and sensory side effects [87].…”

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

“…However, with improvements and advances in magnetic resonance imaging (MRI), direct anatomic targeting of structures such as subthalamic nucleus (STN), globus pallidus interna (GPi), or even ventralis intermedius nucleus (VIM) is now possible. Next, in place of intraoperative electrophysiologic mapping of the structure or test stimulation of symptoms and side effects in the awake patient, the use of intraoperative imaging to verify lead accuracy has been reported in several studies of PD patients undergoing DBS under general anesthesia (“asleep” DBS) . The results demonstrated that the clinical outcomes, complication rates and costs were comparable to those in historical studies using MER to guide lead placement under local anesthesia .…”