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Subthalamic deep brain stimulation under general anesthesia and neurophysiological guidance while on dopaminergic medication: comparative cohort study
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 prese...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Vienna
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859686/ https://www.ncbi.nlm.nih.gov/pubmed/29396602 http://dx.doi.org/10.1007/s00701-018-3473-4 |
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author | Asha, Mohammed Jamil Fisher, Benjamin Kausar, Jamilla Garratt, Hayley Krovvidi, Hari Shirley, Colin White, Anwen Chelvarajah, Ramesh Ughratdar, Ismail Hodson, James A. Pall, Hardev Mitchell, Rosalind D. |
author_facet | Asha, Mohammed Jamil Fisher, Benjamin Kausar, Jamilla Garratt, Hayley Krovvidi, Hari Shirley, Colin White, Anwen Chelvarajah, Ramesh Ughratdar, Ismail Hodson, James A. Pall, Hardev Mitchell, Rosalind D. |
author_sort | Asha, Mohammed Jamil |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-5859686 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Springer Vienna |
record_format | MEDLINE/PubMed |
spelling | pubmed-58596862018-03-22 Subthalamic deep brain stimulation under general anesthesia and neurophysiological guidance while on dopaminergic medication: comparative cohort study Asha, Mohammed Jamil Fisher, Benjamin Kausar, Jamilla Garratt, Hayley Krovvidi, Hari Shirley, Colin White, Anwen Chelvarajah, Ramesh Ughratdar, Ismail Hodson, James A. Pall, Hardev Mitchell, Rosalind D. Acta Neurochir (Wien) Original Article - Functional 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. Springer Vienna 2018-02-02 2018 /pmc/articles/PMC5859686/ /pubmed/29396602 http://dx.doi.org/10.1007/s00701-018-3473-4 Text en © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Article - Functional Asha, Mohammed Jamil Fisher, Benjamin Kausar, Jamilla Garratt, Hayley Krovvidi, Hari Shirley, Colin White, Anwen Chelvarajah, Ramesh Ughratdar, Ismail Hodson, James A. Pall, Hardev Mitchell, Rosalind D. Subthalamic deep brain stimulation under general anesthesia and neurophysiological guidance while on dopaminergic medication: comparative cohort study |
title | Subthalamic deep brain stimulation under general anesthesia and neurophysiological guidance while on dopaminergic medication: comparative cohort study |
title_full | Subthalamic deep brain stimulation under general anesthesia and neurophysiological guidance while on dopaminergic medication: comparative cohort study |
title_fullStr | Subthalamic deep brain stimulation under general anesthesia and neurophysiological guidance while on dopaminergic medication: comparative cohort study |
title_full_unstemmed | Subthalamic deep brain stimulation under general anesthesia and neurophysiological guidance while on dopaminergic medication: comparative cohort study |
title_short | Subthalamic deep brain stimulation under general anesthesia and neurophysiological guidance while on dopaminergic medication: comparative cohort study |
title_sort | subthalamic deep brain stimulation under general anesthesia and neurophysiological guidance while on dopaminergic medication: comparative cohort study |
topic | Original Article - Functional |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859686/ https://www.ncbi.nlm.nih.gov/pubmed/29396602 http://dx.doi.org/10.1007/s00701-018-3473-4 |
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