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Wang J, Ponce FA, Tao J, Yu HM, Liu JY, Wang YJ, Luan GM, Ou SW. Comparison of Awake and Asleep Deep Brain Stimulation for Parkinson's Disease: A Detailed Analysis Through Literature Review. Neuromodulation 2019; 23:444-450. [PMID: 31830772 DOI: 10.1111/ner.13061] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/22/2019] [Accepted: 09/11/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Deep brain stimulation (DBS) for Parkinson's disease (PD) has been applied to clinic for approximately 30 years. The goal of this review is to explore the similarities and differences between "awake" and "asleep" DBS techniques. METHODS A comprehensive literature review was carried out to identify relevant studies and review articles describing applications of "awake" or "asleep" DBS for Parkinson's disease. The surgical procedures, clinical outcomes, costs and complications of each technique were compared in detail through literature review. RESULTS The surgical procedures of awake and asleep DBS surgeries rely upon different methods for verification of intended target acquisition. The existing research results demonstrated that the stereotactic targeting accuracy of lead placement obtained by either method is reliable. There were no significant differences in clinical outcomes, costs, or complications between the two techniques. CONCLUSION The surgical and clinical outcomes of asleep DBS for PD are comparable to those of awake DBS.
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Affiliation(s)
- Jun Wang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jun Tao
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Hong-Mei Yu
- Department of Neurology, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Ji-Yuan Liu
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Yun-Jie Wang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Guo-Ming Luan
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, P. R., China
| | - Shao-Wu Ou
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
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Five-Year Clinical Outcomes of Local versus General Anesthesia Deep Brain Stimulation for Parkinson's Disease. PARKINSONS DISEASE 2019; 2019:5676345. [PMID: 30800263 PMCID: PMC6360066 DOI: 10.1155/2019/5676345] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/15/2018] [Accepted: 12/06/2018] [Indexed: 12/03/2022]
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.
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Kremer NI, Oterdoom DLM, van Laar PJ, Piña-Fuentes D, van Laar T, Drost G, van Hulzen ALJ, van Dijk JMC. Accuracy of Intraoperative Computed Tomography in Deep Brain Stimulation-A Prospective Noninferiority Study. Neuromodulation 2019; 22:472-477. [PMID: 30629330 PMCID: PMC6618091 DOI: 10.1111/ner.12918] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/04/2018] [Accepted: 11/30/2018] [Indexed: 01/09/2023]
Abstract
Introduction Clinical response to deep brain stimulation (DBS) strongly depends on the appropriate placement of the electrode in the targeted structure. Postoperative MRI is recognized as the gold standard to verify the DBS‐electrode position in relation to the intended anatomical target. However, intraoperative computed tomography (iCT) might be a feasible alternative to MRI. Materials and Methods In this prospective noninferiority study, we compared iCT with postoperative MRI (24‐72 hours after surgery) in 29 consecutive patients undergoing placement of 58 DBS electrodes. The primary outcome was defined as the difference in Euclidean distance between lead tip coordinates as determined on both imaging modalities, using the lead tip depicted on MRI as reference. Secondary outcomes were difference in radial error and depth, as well as difference in accuracy relative to target. Results The mean difference between the lead tips was 0.98 ± 0.49 mm (0.97 ± 0.47 mm for the left‐sided electrodes and 1.00 ± 0.53 mm for the right‐sided electrodes). The upper confidence interval (95% CI, 0.851 to 1.112) did not exceed the noninferiority margin established. The average radial error between lead tips was 0.74 ± 0.48 mm and the average depth error was determined to be 0.53 ± 0.40 mm. The linear Deming regression indicated a good agreement between both imaging modalities regarding accuracy relative to target. Conclusions Intraoperative CT is noninferior to MRI for the verification of the DBS‐electrode position. CT and MRI have their specific benefits, but both should be considered equally suitable for assessing accuracy.
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Affiliation(s)
- Naomi I Kremer
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D L Marinus Oterdoom
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Jan van Laar
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dan Piña-Fuentes
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea Drost
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjen L J van Hulzen
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Warnke P. Deep brain stimulation: awake or asleep: it comes with a price either way. J Neurol Neurosurg Psychiatry 2018; 89:672. [PMID: 29550787 DOI: 10.1136/jnnp-2017-315710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/03/2018] [Indexed: 11/04/2022]
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Tsai ST, Kuo CC, Chen TY, Chen SY. Neurophysiological comparisons of subthalamic deep-brain stimulation for Parkinson's disease between patients receiving general and local anesthesia. Tzu Chi Med J 2016; 28:63-67. [PMID: 28757724 PMCID: PMC5442892 DOI: 10.1016/j.tcmj.2016.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/15/2016] [Accepted: 02/18/2016] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Sheng-Tzung Tsai
- Department of Neurosurgery, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Chung-Chih Kuo
- Department of Physiology, Tzu Chi University, Hualien, Taiwan
| | - Tsung-Ying Chen
- Department of Anesthesiology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Shin-Yuan Chen
- Department of Neurosurgery, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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Lange M, Zech N, Seemann M, Janzen A, Halbing D, Zeman F, Doenitz C, Rothenfusser E, Hansen E, Brawanski A, Schlaier J. Anesthesiologic regimen and intraoperative delirium in deep brain stimulation surgery for Parkinson's disease. J Neurol Sci 2015; 355:168-73. [PMID: 26073485 DOI: 10.1016/j.jns.2015.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 05/23/2015] [Accepted: 06/07/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In many centers the standard anesthesiological care for deep brain stimulation (DBS) surgery in Parkinson's disease patients is an asleep-awake-asleep procedure. However, sedative drugs and anesthetics can compromise ventilation and hemodynamic stability during the operation and some patients develop a delirious mental state after the initial asleep phase. Further, these drugs interfere with the patient's alertness and cooperativeness, the quality of microelectrode recordings, and the recognition of undesired stimulation effects. In this study, we correlated the incidence of intraoperative delirium with the amount of anesthetics used intraoperatively. METHODS The anesthesiologic approach is based on continuous presence and care, avoidance of negative suggestions, use of positive suggestions, and utilization of the patient's own resources. Clinical data from the operations were analyzed retrospectively, the occurrence of intraoperative delirium was extracted from patients' charts. The last 16 patients undergoing the standard conscious sedation procedure (group I) were compared to the first 22 (group II) psychologically-guided patients. RESULTS The median amount of propofol decreased from 146 mg (group I) to 0mg (group II), remifentanyl from 0.70 mg to 0.00 mg, respectively (P<0.001 for propofol and remifentanyl). Using the new procedure, 12 of 22 patients (55%) in group II required no anesthetics. Intraoperative delirium was significantly less frequent in group II (P=0.03). CONCLUSIONS The occurrence of intraoperative delirium correlates with the amount of intraoperative sedative and anesthetic drugs. Sedation and powerful analgesia are not prerequisites for patients' comfort during awake-DBS-surgery.
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Affiliation(s)
- M Lange
- Department of Neurosurgery, University of Regensburg, Medical Center, Germany; Centre for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany
| | - N Zech
- Centre for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany; Department of Anesthesiology, University of Regensburg, Medical Center, Germany
| | - M Seemann
- Centre for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany; Department of Anesthesiology, University of Regensburg, Medical Center, Germany
| | - A Janzen
- Centre for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany; Department of Neurology, University of Regensburg, Medical Center, Germany
| | - D Halbing
- Department of Neurosurgery, University of Regensburg, Medical Center, Germany
| | - F Zeman
- Center for Clinical Studies, University of Regensburg, Medical Center, Germany
| | - C Doenitz
- Department of Neurosurgery, University of Regensburg, Medical Center, Germany
| | - E Rothenfusser
- Centre for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany; Department of Neurology, University of Regensburg, Medical Center, Germany
| | - E Hansen
- Centre for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany; Department of Anesthesiology, University of Regensburg, Medical Center, Germany
| | - A Brawanski
- Department of Neurosurgery, University of Regensburg, Medical Center, Germany
| | - J Schlaier
- Department of Neurosurgery, University of Regensburg, Medical Center, Germany; Centre for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany.
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