Bilateral stimulation of the subthalamic nucleus under local and general anaesthesia

Abstract

Introduction. Bilateral stimulation of the subthalamic nucleus (STN) is successfully used to treat advanced stages of Parkinson's disease. The standard surgical technique includes microelectrode recording and intraoperative stimulation. The introduction of 3T MRI into clinical practice and new impulse sequences have led to the question of whether the surgery can be performed under general anaesthesia.
 Aim of the study: to compare the efficacy and safety of bilateral stimulation of STN in patients with Parkinson's disease, using 3T MRI under local and general anaesthesia.
 Materials and methods. This prospective, randomized controlled study included 40 patients, who underwent electrode implantation using 3T MRI. The patients in the main group (n = 20) had electrodes implanted under general anaesthesia, while the control group (n = 20) had local anaesthesia, intraoperative stimulation and microelectrode recording. The patients motor status, quality of life, cognitive function and required levodopa dose were evaluated after 6 months.
 Results. The results of 6 months of stimulation were obtained from 30 patients (15 from the main group and 15 from the control group). Reduced motor impairment was observed in both groups as measured on the UPDRS III scale during the 'off' time, with a reduction of 68.7% in the main group and 74.7% in the control group. Improved quality of life, reduced drug-induced motor complications and a reduction in the levodopa dose were also comparable in both groups. No intraoperative haemorrhagic complications were recorded during the study.
 Conclusions. Preliminary analysis of the data showed that with high-quality visualization of the STN, electrode implantation under anaesthesia is equally effective to awake surgery.