Subthalamic Deep Brain Stimulation in Parkinson’s Disease under Different Anesthetic Modalities: A Comparative Cohort Study

Abstract

Background: The efficacy and feasibility of bilateral subthalamic deep brain stimulation (STN-DBS) for Parkinson’s disease (PD) under general anesthesia (GA) has not been evaluated. Objective: We compared the outcome of patients under GA with those who were operated on under local anesthesia (LA). Material and Methods: Thirty-three patients were assigned to the GA group (desflurane) and 19 patients were assigned to the LA group. Microelectrode recording (MER) was performed in both groups. The surgical outcomes of the patients were evaluated using the Unified Parkinson’s Disease Rating Scale (UPDRS) after at least 12 months after surgery. Results: Postoperatively, there was no significant difference on the UPDRS scores in either groups. A significant deterioration in cognitive function in the GA group was observed (p = 0.017). The recorded electrode coordinates, the average tracts for the MER, and STN depth were comparable in both groups. The overall incidence of adverse effects did not show any difference except that the incidence of sialorrhea and dysarthria was significantly higher in the GA group. Conclusion: Desflurane GA was shown to be a good alternative anesthetic method for PD patients undergoing DBS. Although the motor outcomes were comparable, a significant cognitive decline may be seen in the GA group with a higher occurrence of stimulation side effects.

Awake Neurophysiologically Guided versus Asleep MRI-Guided STN DBS for Parkinson Disease: A Comparison of Outcomes Using Levodopa Equivalents

“…Regardless of PRN dosing interpretations, the trend is unchanged, with patients in both groups exhibiting a significant LEDD decrease. Previous studies comparing awake and asleep DBS for PD patients have shown similar reductions in levodopa equivalents between 3 and 6 months [6,8,13,14,15,16]. Lower doses of levodopa have been associated with a lower likelihood of having dyskinesias, wearing-off phenomenon, and motor complications [1,2,3].…”

“…Testing performed during these awake, off-medication surgeries included microelectrode recording and test stimulation. Recently, with patients under general anesthesia, direct targeting of the STN using intraoperative magnetic resonance imaging (MRI) or computed tomography (CT) to guide DBS lead placement has been implemented at several institutions, including ours [5,6,7,8,9,10,11]. The availability of this surgical technique provides patients unwilling or unable to tolerate awake surgery with an alternative option for DBS lead placement.…”

“…The availability of this surgical technique provides patients unwilling or unable to tolerate awake surgery with an alternative option for DBS lead placement. Previous studies on asleep DBS lead placement with the use of intraoperative imaging have indicated that this may be an appropriate surgical technique, but only a limited number have evaluated the postoperative clinical outcomes in a quantitative fashion [6,8,10,12,13,14,15,16]. This study retrospectively compares the efficacy of STN DBS for PD in two groups of patients at a single institution.…”

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

“…This characteristic may lead to a higher stimulation side effect during clinical follow-up. 5 In addition to determining the correlation between the STN topography and the characteristic signal, enhancing MER neuronal signals under conditioned general anesthesia might facilitate the improvement of DBS outcomes.…”

Factors Associated with Tremor Changes during Sedation with Dexmedetomidine in Parkinson's Disease Surgery

“…During surgery, the patient's head is fixed on a stereotactic frame, and as they are off their usual medication, the discomfort of rigidity and tremor can be difficult to manage. Also, the natural anxiety surrounding a surgical procedure can make blood pressure difficult to control and preclude patient cooperation after a few hours, increasing the potential for intraoperative complications [7,8] such as respiratory problems or intracerebral hemorrhage.…”