P 72 Influence of anesthesia on the outcome in patients with Parkinson’s disease undergoing deep brain stimulation of the subthalamic nucleus

Abstract

Background Currently, implantation of electrodes for Deep Brain Stimulation (DBS) as a treatment for patients with Parkinson’s Disease (PD) is usually performed under local anaesthesia (LA) to allow intraoperative testing of effects and side effects. Recently, several studies have indicated that surgery under general anaesthesia (GA) may lead to comparable outcomes. However, most of these studies did not compare the types of anesthesia directly. Objective This study aims to investigate whether the type of anesthesia (LA vs. GA) affects the outcome of motor and cognitive symptoms and reduction of levodopa-equivalent daily dose (LEDD) after subthalamic nucleus (STN)-DBS over a period of one year in a large single center population. Methods 48 patients underwent DBS in GA between 2008 and 2015 at the center of movement disorders in Dusseldorf. From the other 140 patients operated by the standard procedure in LA in the same period of time, 48 patients were matched to the GA group. These groups were compared regarding improvement in motor function measured by the Unified Parkinson’s Disease Rating Scale (UPDRS) III, decrease of LEDD, setting of stimulation parameters, cognitive function measured with neuropsychological tests and occurrence of stimulation induced side effect. Results Motor function measured by the UPDRS III score in the medication off, stimulation on state was significantly better in the LA group compared to the GA group. Subscore analysis revealed that axial symptoms “freezing” and “speech” were significantly worse in the GA group at three months and one year, respectively. Postoperative LEDD-reduction was significant in both groups and did not differ between the groups over the whole period of one year. There were no significant differences of stimulation amplitude and cognition between the groups. Stimulation induced side effects tended to be less frequent in the LA group but did not reach statistical significance. Conclusions In our study, motor function of patients undergoing DBS surgery in LA improved significantly more over the period of one year postoperatively compared to those operated in GA. Furthermore postoperative stimulation induced side effects tended to be less frequent in the LA group. We therefore conclude that surgery in LA with intraoperative testing is still significantly advantageous for PD patients undergoing STN-DBS and should be first choice if there are no other specific limitations that make GA unavoidable.