Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug;165(8):2179-2187.
doi: 10.1007/s00701-023-05624-4. Epub 2023 Jun 2.

Factors influencing the reliability of intraoperative testing in deep brain stimulation for Parkinson's disease

Tobias Mederer  1 , Daniel Deuter  1 , Elisabeth Bründl  1 , Patricia Forras  2 , Nils Ole Schmidt  1 , Zacharias Kohl  2 , Jürgen Schlaier  3
Affiliations

Factors influencing the reliability of intraoperative testing in deep brain stimulation for Parkinson's disease

Tobias Mederer et al. Acta Neurochir (Wien). 2023 Aug.

Abstract

Background: Several meta-analyses comparing the outcome of awake versus asleep deep brain stimulation procedures could not reveal significant differences concerning the postoperative improvement of motor symptoms. Only rarely information on the procedural details is provided for awake operations and how often somnolence and disorientation occurred, which might hamper the reliability of intraoperative clinical testing. The aim of our study was to investigate possible influencing factors on the occurrence of somnolence and disorientation in awake DBS procedures.

Methods: We retrospectively analyzed 122 patients with Parkinson's disease having received implantation of a DBS system at our centre. Correlation analyses were performed for the duration of disease prior to surgery, number of microelectrode trajectories, AC-PC-coordinates of the planned target, UPDRS-scores, intraoperative application of sedative drugs, duration of the surgical procedure, perioperative application of apomorphine, and the preoperative L-DOPA equivalence dosage with the occurrence of intraoperative somnolence and disorientation.

Results: Patients with intraoperative somnolence were significantly older (p=0.039). Increased duration of the DBS procedure (p=0.020), delayed start of the surgery (p=0.049), higher number of MER trajectories (p=0.041), and the patients' % UPDRS improvement (p=0.046) also correlated with the incidence of intraoperative somnolence. We identified the main contributing factor to intraoperative somnolence as the use of sedative drugs applied during skin incision and burr hole trepanation (p=0.019). Perioperatively applied apomorphine could reduce the occurrence of somnolent phases during the operation (p=0.026).

Conclusion: Several influencing factors were found to seemingly increase the risk of intraoperative somnolence and disorientation, while the use of sedative drugs seems to be the main contributing factor. We argue that awake DBS procedures should omit the use of sedatives for best clinical outcome. When reporting on awake DBS surgery these factors should be considered and adjusted for, to permit reliable interpretation and comparison of DBS study results.

Keywords: Deep brain stimulation; Parkinson’s disease; Intraoperative clinical testing; Subthalamic nucleus.

PubMed Disclaimer

Conflict of interest statement

Tobias Mederer and Daniel Deuter have received travel grants for educational purposes from Medtronic. Juergen Schlaier has received teaching fees from Medtronic and research support from St Jude Medical, Antisense Pharma, and Medtronic. Talks in the last years were partly sponsored by Medtronic, St Jude Medical, and BrainLab. In addition, he received compensation from Medtronic for his services as a consultant. The remaining authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
The occurrence of somnolence based on number of MER implanted for testing on a) the first operated side and b) second operated side (total number of MER)
See this image and copyright information in PMC

References

    1. Abosch A, Timmermann L, Bartley S, Rietkerk HG, Whiting D, Connolly PJ, Lanctin D, Hariz MI. An international survey of deep brain stimulation procedural steps. Stereotact Funct Neurosurg. 2013;91:1–11. doi: 10.1159/000343207. - DOI - PubMed
    1. Aziz TZ, Hariz M (2017) To sleep or not to sleep during deep brain stimulation surgery for Parkinson disease? Neurology - PubMed
    1. Bejjani BP, Dormont D, Pidoux B, Yelnik J, Damier P, Arnulf I, Bonnet a M, Marsault C, Agid Y, Philippon J, Cornu P. Bilateral subthalamic stimulation for Parkinson’s disease by using three-dimensional stereotactic magnetic resonance imaging and electrophysiological guidance. J Neurosurg. 2000;92:615–625. doi: 10.3171/jns.2000.92.4.0615. - DOI - PubMed
    1. Benabid AL, Krack PP, Benazzouz A, Limousin P, Koudsie A, Pollak P. Deep brain stimulation of the subthalamic nucleus for Parkinson’s disease: methodologic aspects and clinical criteria. Neurology. 2000;55:S40–S44. - PubMed
    1. Blasberg F, Wojtecki L, Elben S, Slotty PJ, Vesper J, Schnitzler A, Groiss SJ (2018) Comparison of Awake vs. Asleep Surgery for Subthalamic Deep Brain Stimulation in Parkinson’s Disease. Neuromodulation 2018 - PubMed

Publication types