Objective: The aim of the study was to compare outcomes of the deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with Parkinson’s disease (PD) operated under general vs local anesthesia.

Background: Performing DBS of the STN under general anesthesia using direct visualization provides less operative time and more comfortable conditions for patients. However, this technique doesn’t allow performing intraoperative assessment of the therapeutic and side effects thresholds. Therefore, the relevance of the asleep DBS should be confirmed in the prospective comparative studies.

Method: 40 patients with the PD were included in the prospective randomized controlled trial. 20 patients were randomized to have DBS of the STN under general anesthesia with intraoperative CT. The control group included 20 patients randomized to have DBS of the STN under local anesthesia with microelectrode registration and intraoperative stimulation. All patients have undergone 3T MRI (FSPGR BRAVO, high-resolution T2, T2-FLAIR, and SWAN). Acquired images were fused with intraoperative CT using StealthMerge (StealthStation, Medtronic). Results of the treatment were analyzed 6 months postoperatively using standard scales.

Results: The decrease of the motor symptoms in the off-state accounted for 68,2% in the main group and for 70,9% in the control group, assessed by the UPDRS III 6 months postoperatively. In the on-medication state, improvement in the motor function equaled 42,4% and 43,1 % in the asleep and awake groups, respectively. Statistically significant differences between the two groups haven’t been found (Mann-Whitney U Test, p>0,05). Activities of daily living assessed by the Schwab and England scale in the off-medication state increased on 30% in the awake group vs 20% in the asleep group with the significant differences between the two groups (Mann-Whitney U Test, p<0,05). Both groups didn’t show significant changes in the on-state (Wilcoxon matched pairs test, p>0,05). No intraoperative hemorrhages were found in the both groups. Persisting dysarthria after the correction of the stimulation program was found in 2 patients in the asleep group vs 1 patient in the awake group.

Conclusion: The efficacy and safety of the DBS of the STN in patients with Parkinson’s disease operated under general anesthesia with 3T MRI and intraoperative CT is comparable with the standard technique 6 months postoperatively.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-of-the-subthalamic-nucleus-under-general-vs-local-anesthesia/