Abstract
Deep brain stimulation (DBS) surgery of the subthalamic nucleus (STN) under general anesthesia (GA) had been used in Parkinson's disease (PD) patients who are unable tolerate awake surgery. The effect of anesthetics on intraoperative microelectrode recording (MER) remains unclear. Understanding the effect of anesthetics on MER is important in performing STN DBS surgery with general anesthesia. In this study, we retrospectively performed qualitive and quantitative analysis of STN MER in PD patients received STN DBS with controlled desflurane anesthesia or LA and compared their clinical outcome. From January 2005 to March 2006, 19 consecutive PD patients received bilateral STN DBS surgery in Hualien Tzu-Chi hospital under either desflurane GA (n = 10) or LA (n = 9). We used spike analysis (frequency and modified burst index [MBI]) and the Hilbert transform to obtain signal power measurements for background and spikes, and compared the characterizations of intraoperative microelectrode signals between the two groups. Additionally, STN firing pattern characteristics were determined using a combined approach based on the autocorrelogram and power spectral analysis, which was employed to investigate differences in the oscillatory activities between the groups. Clinical outcomes were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) before and after surgery. The results revealed burst firing was observed in both groups. The firing frequencies were greater in the LA group and MBI was comparable in both groups. Both the background and spikes were of significantly greater power in the LA group. The power spectra of the autocorrelograms were significantly higher in the GA group between 4 and 8 Hz. Clinical outcomes based on the UPDRS were comparable in both groups before and after DBS surgery. Under controlled light desflurane GA, burst features of the neuronal firing patterns are preserved in the STN, but power is reduced. Enhanced low-frequency (4–8 Hz) oscillations in the MERs for the GA group could be a characteristic signature of desflurane's effect on neurons in the STN.
Highlights
Deep brain stimulation (DBS) surgery has been used for treating movement disorders for 30 years (Benabid et al, 1987)
A followup examination of general anesthesia (GA) and local anesthesia (LA) groups at 6 months after surgery revealed that STN-DBS significantly improved UPDRS scores collected in the ON states compared with those collected in the OFF state (p < 0.01, Wilcoxon signed-rank test)
The clinical outcomes for our patients were comparable to those found in previous studies (Hertel et al, 2006; Harries et al, 2012), and the provide evidence that the effect of subthalamic nuclei DBS (STN DBS) surgery on Parkinson’s disease (PD) patients is equivalent regardless of anesthesia method (LA or controlled desflurane inhalation)
Summary
Deep brain stimulation (DBS) surgery has been used for treating movement disorders for 30 years (Benabid et al, 1987). To obtain clear STN signals, most STN DBS surgeries are performed under local anesthesia (LA) (Rezai et al, 2006). PD patients with severe anxiety, rigidity, and dystonia, or even respiratory difficulty because of a lack of medication are considered unable to tolerate awake DBS surgery (Hertel et al, 2006). These patients must undergo STN DBS surgery with either conscious sedation or general anesthesia (GA) (Bindu and Bithal, 2016). Major concerns about DBS surgery under GA are (1) the loss of some features in the microelectrode signal and (2) the inability to test stimulation
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