Neurophysiological comparisons of subthalamic deep-brain stimulation for Parkinson's disease between patients receiving general and local anesthesia

Sheng-Tzung Tsai, Chung-Chih Kuo, Tsung-Ying Chen, Shin-Yuan Chen, Sheng-Tzung Tsai, Chung-Chih Kuo, Tsung-Ying Chen, Shin-Yuan Chen

Abstract

Objectives: Subthalamic nucleus deep-brain stimulation (STN-DBS) is suggested as a standard treatment for patients with Parkinson's disease (PD) and drug-related side effects. Most centers perform the operation under local anesthesia (LA) to ensure better microelectrode recording (MER). Given the advances in imaging and MER, general anesthesia (GA) is perceived as an alternative choice for PD patients undergoing STN-DBS. However, the outcomes in terms of clinical symptoms and MER after GA have rarely been reported. In this report, we compared the outcomes after STN-DBS for PD between patients receiving LA and GA.

Materials and methods: We included 16 patients with comparable severity of PD undergoing either GA (n = 8) or LA (n = 8) for STN-DBS. MER was performed in all patients for STN localization, and surgical outcomes were evaluated using the Unified PD Rating Scales, and Mini-mental status examination. All adverse effects were documented.

Results: Both groups (GA and LA) acquired similar benefits from STN-DBS, and there were no significant differences in neuropsychiatric outcome analysis between groups. There were no significant differences in stimulation parameters and adverse effects from STN-DBS between groups. The GA group had a trend toward a lower frequency rate of STN firing on MER.

Conclusion: Although the GA group has a lower neuronal firing frequency in the STN during surgery, STN-DBS under GA showed comparable and non-inferior outcomes as compared with STN-DBS under LA.

Keywords: Deep-brain stimulation; General anesthesia; Parkinson's disease.

Conflict of interest statement

Conflicts of interest: none.

Figures

Fig. 1
Fig. 1
Representative raw neuronal firings from the subthalamic nucleus in patients with Parkinson's disease under general and local anesthesia.

References

    1. Jiang JL, Lo SF, Tsai ST, Chen SY. A systematic review of the impact of sub-thalamic nucleus stimulation on the quality of life of patients with Parkinson's disease. Tzu Chi Med J. 2014;26:15–20.
    1. Jiang JL, Chen SY, Hsieh TC, Lee CW, Lin SH, Tsai ST. Different effectiveness of subthalamic deep brain stimulation in Parkinson's disease: a comparative cohort study at 1 year and 5 years. J Formos Med Assoc. 2015;114:835–41.
    1. Warnke PC. Deep brain stimulation surgery under general anaesthesia with microelectrode recording: the best of both worlds or a little bit of everything? J Neurol Neurosurg Psychiatry. 2014;85:1063.
    1. Fenoy AJ, Simpson RK. Risks of common complications in deep brain stimulation surgery: management and avoidance. J Neurosurg. 2014;120:132–9.
    1. Raz A, Eimerl D, Zaidel A, Bergman H, Israel Z. Propofol decreases neuronal population spiking activity in the subthalamic nucleus of Parkinsonian patients. Anesth Analg. 2010;111:1285–9.
    1. Lin SH, Chen TY, Lin SZ, Shyr MH, Chou YC, Hsieh WA, et al. Subthalamic deep brain stimulation after anesthetic inhalation in Parkinson disease: a preliminary study. J Neurosurg. 2008;109:238–44.
    1. Fasano A, Romito LM, Daniele A, Piano C, Zinno M, Bentivoglio AR, et al. Motor and cognitive outcome in patients with Parkinson's disease 8 years after subthalamic implants. Brain. 2010;133:2664–76.
    1. Castrioto A, Lozano AM, Poon YY, Lang AE, Fallis M, Moro E. Ten-year outcome of subthalamic stimulation in Parkinson disease: a blinded evaluation. Arch Neurol. 2011;68:1550–6.
    1. Zibetti M, Merola A, Rizzi L, Ricchi V, Angrisano S, Azzaro C, et al. Beyond nine years of continuous subthalamic nucleus deep brain stimulation in Parkinson's disease. Mov Disord. 2011;26:2327–34.
    1. Tsai ST, Lin SH, Hung HY, Lin SZ, Chen SY. Long-term comparison of sub-thalamic nucleus stimulation between patients with young-onset and late-onset Parkinson's disease. Tzu Chi Med J. 2012;24:65–72.
    1. Tsai ST, Hung HY, Hsieh TC, Lin SH, Lin SZ, Chen SY. Long-term outcome of young onset Parkinson's disease after subthalamic stimulation–A cross-sectional study. Clin Neurol Neurosurg. 2013;115:2082–7.
    1. Fluchere F, Witjas T, Eusebio A, Bruder N, Giorgi R, Leveque M, et al. Controlled general anaesthesia for subthalamic nucleus stimulation in Parkinson's disease. J Neurol Neurosurg Psychiatry. 2014;85:1167–73.
    1. Hung HY, Tsai ST, Lin SH, Jiang JL, Chen SY. Uneven benefits of subthalamic nucleus deep brain stimulation in Parkinson's disease-A 7-year cross-sectional study. Tzu Chi Med J. 2013;25:239–45.
    1. Tsai ST, Lin SH, Lin SZ, Chen JY, Lee CW, Chen SY. Neuropsychological effects after chronic subthalamic stimulation and the topography of the nucleus in Parkinson's disease. Neurosurgery. 2007;61:E1024–9. discussion E1029-30.
    1. Gross RE, Krack P, Rodriguez-Oroz MC, Rezai AR, Benabid AL. Electrophysio-logical mapping for the implantation of deep brain stimulators for Parkinson's disease and tremor. Mov Disord. 2006;21:S259–83.
    1. Anheim M, Batir A, Fraix V, Silem M, Chabardes S, Seigneuret E, et al. Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation. Arch Neurol. 2008;65:612–6.
    1. Hertel F, Züchner M, Weimar I, Gemmar P, Noll B, Bettag M, et al. Implantation of electrodes for deep brain stimulation of the subthalamic nucleus in advanced Parkinson's disease with the aid of intraoperative microrecording under general anesthesia. Neurosurgery. 2006;59:E1138. discussion E1138.
    1. Harries AM, Kausar J, Roberts SAG, Mocroft AP, Hodson JA, Pall HS, et al. Deep brain stimulation of the subthalamic nucleus for advanced Parkinson disease using general anesthesia: long-term results. J Neurosurg. 2012;116:107–13.
    1. Tsai ST, Hung HY, Chen SY. Deep brain stimulation modifies cognitive function. Tzu Chi Med J. 2013;25:86–9.
    1. Lettieri C, Rinaldo S, Devigili G, Pauletto G, Verriello L, Budai R, et al. Deep brain stimulation: subthalamic nucleus electrophysiological activity in awake and anesthetized patients. Clin Neurophysiol. 2012;123:2406–13.
    1. Mayberg TS, Lam AM, Matta BF, Domino KB, Winn HR. Ketamine does not increase cerebral blood flow velocity or intracranial pressure during iso-flurane/nitrous oxide anesthesia in patients undergoing craniotomy. Anesth Analg. 1995;81:84–9.
    1. Burchiel KJ, McCartney S, Lee A, Raslan AM. Accuracy of deep brain stimulation electrode placement using intraoperative computed tomography without microelectrode recording. J Neurosurg. 2013;119:301–6.
    1. Yoshida F, Martinez-Torres I, Pogosyan A, Holl E, Petersen E, Chen CC, et al. Value of subthalamic nucleus local field potentials recordings in predicting stimulation parameters for deep brain stimulation in Parkinson's disease. J Neurology, Neurosurg Psychiatry. 2010;81:885–9.
    1. Brown EN, Purdon PL, Van Dort CJ. General anesthesia and altered states of arousal: a systems neuroscience analysis. Annu Rev Neurosci. 2011;34:601–28.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다