Subthalamic deep brain stimulation under general anesthesia and neurophysiological guidance while on dopaminergic medication

Acta Neurochirurgica (2018) 160:823–829

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 Btime needed for extubation^ and Btotal time of recovery.^ Data for the Bstudy group^ was collected prospectively. Examined variables were compared between the Bstudy group^ and Bhistorical control group^ who stopped dopaminergic therapy preoperatively. Results The study group, n = 30 (May 2014–Jan 2016), were slightly younger than the Bcontrol 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.