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Comparative Study
. 2018 Apr;160(4):823-829.
doi: 10.1007/s00701-018-3473-4. Epub 2018 Feb 2.

Subthalamic deep brain stimulation under general anesthesia and neurophysiological guidance while on dopaminergic medication: comparative cohort study

Mohammed Jamil Asha  1 , Benjamin Fisher  2 , Jamilla Kausar  2 , Hayley Garratt  2 , Hari Krovvidi  3 , Colin Shirley  4 , Anwen White  2 , Ramesh Chelvarajah  2 , Ismail Ughratdar  2 , James A Hodson  5 , Hardev Pall  6 , Rosalind D Mitchell  2
Affiliations
Comparative Study

Subthalamic deep brain stimulation under general anesthesia and neurophysiological guidance while on dopaminergic medication: comparative cohort study

Mohammed Jamil Asha et al. Acta Neurochir (Wien). 2018 Apr.

Abstract

Objectives: The authors have previously reported on the technical feasibility of subthalamic nucleus deep brain stimulation (STN DBS) under general anesthesia (GA) with microelectrode recording (MER) guidance in Parkinsonian patients who continued dopaminergic therapy until surgery. This paper presents the results of a prospective cohort analysis to verify the outcome of the initial study, and report on wider aspects of clinical outcome and postoperative recovery.

Methods: All patients in the study group continued dopaminergic therapy until GA was administered. Baseline characteristics, intraoperative neurophysiological markers, and perioperative complications were recorded. Long-term outcome was assessed using selective aspects of the unified Parkinson's disease rating scale motor score. Immediate postoperative recovery from GA was assessed using the "time needed for extubation" and "total time of recovery." Data for the "study group" was collected prospectively. Examined variables were compared between the "study group" and "historical control group" who stopped dopaminergic therapy preoperatively.

Results: The study group, n = 30 (May 2014-Jan 2016), were slightly younger than the "control group," 60 (51-64) vs. 64 (56-69) years respectively, p = 0.043. Both groups were comparable for the recorded intraoperative neurophysiological parameters; "number of MER tracks": 60% of the "study group" had single track vs. 58% in the "control" group, p = 1.0. Length of STN MER detected was 9 vs. 7 mm (median) respectively, p = 0.037. A trend towards better recovery from GA in the study group was noted, with shorter "total recovery time": 60 (50-84) vs. 89 (62-120) min, p = 0.09. Long-term improvement in motor scores and reduction in L-dopa daily equivalent dose were equally comparable between both groups. No cases of dopamine withdrawal or problems with immediate postop dyskinesia were recorded in the "on medications group." The observed rate of dopamine-withdrawal side effects in the "off-medications" group was 15%.

Conclusions: The continuation of dopaminergic treatment for patients with PD does not affect the feasibility/outcome of the STN DBS surgery. This strategy appears to reduce the risk of dopamine-withdrawal adverse effects and may improve the recovery in the immediate postoperative period, which would help enhance patients' perioperative experience.

Keywords: Dopaminergic therapy; General anesthesia; Microelectrode recording; Parkinson disease; Subthalamic nucleus deep brain stimulation.

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Conflict of interest statement

Conflict of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (University Hospital Birmingham—NHS Trust) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

    1. Abosch A, Lanctin D, Onaran I, Eberly L, Spaniol M, Ince NF. Long-term recordings of local field potentials from implanted deep brain stimulation electrodes. Neurosurgery. 2012;71(4):804–814. doi: 10.1227/NEU.0b013e3182676b91. - DOI - PubMed
    1. Alesch F, Jain R, Chen L, Brucke T, Seijo F, San Martin ES, Haegelen C, Verin M, Maarouf M, Barbe MT, Gill S, Whone A, Porta M, Servello D, Timmermann LA. Comparison of outcomes between deep brain stimulation under general anesthesia versus conscious sedation with awake evaluation. Neurosurgery. 2016;63(Suppl 1):155. doi: 10.1227/01.neu.0000489705.76089.c2. - DOI
    1. Asha MJ, Kausar J, Krovvidi H, Shirley C, White A, Chelvarajah R, Hodson JA, Pall H, Mitchell RD. The effect of dopaminergic therapy on intraoperative microelectrode recordings for subthalamic deep brain stimulation under GA: can we operate on patients ‘on medications’? Acta Neurochir. 2016;158(2):387–393. doi: 10.1007/s00701-015-2631-1. - DOI - PubMed
    1. Asha M, Kausar J, Krovvidi H, Shirely C, White A, Chelvarajah R, Pall H, Mitchell R. Subthalamic nucleus microelectrode recordings (MER) can be reliably detected despite general anaesthesia and dopaminergic treatment. Acta Neurochir. 2016;158(5):1015–1016. doi: 10.1007/s00701-016-2758-8. - DOI - PubMed
    1. Binder DK, Rau G, Starr PA. Hemorrhagic complications of microelectrode-guided deep brain stimulation. Stereotact Funct Neurosurg. 2003;80(1–4):28–31. doi: 10.1159/000075156. - DOI - PubMed

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