Category: Surgical Therapy: Parkinson's Disease
Objective: Comparison of the efficacy of STN neuromodulation after surgical intervention with Monitored Anesthesia Care (MAC) and using general anesthesia (GA).
Background: The effectiveness of neuromodulation STN depends not only on the correct selection of patients, but also on the accuracy of electrode implantation in the target structure. The accuracy of electrode implantation may differ depending on the type of anesthesia [1,2].
Method: 30 patients with PD was underwent bilateral electrode implantation in the STN from 2014 to 2023. The mean age of the patients was 59[53;62] years. Surgical intervention with MAC (group 1) was performed in 66.7% of cases (n=20), and under GA (group 2) in 33.3% of cases (n=10). The neurological status of patients was evaluated according to the III part of the UPDRS scale in the off period before surgery, 1 and 6 months after surgery.
Results: In group 1, deviation of more than 1 mm from the planned trajectory occurred in 90% of cases (n=18). The mean deviation was: 1.7 mm ventrally in 25%; 3.4 mm dorsally in 10%; 2.1 mm medially in 25%; 2.9 mm laterally in 35%; 5.8 mm cranially in 10% and 2.3 mm caudally in 60%
In group 2, deviations greater than 1 mm from the planned trajectory occurred in 50% of cases (n=5). The average deviation was: 5.3 mm cranially in 20%; 1.9 mm caudally in 30%.
In group 1, the UPDRS part III scores were 28.5[22;36.5] points after 1 month and 25.5[19;31.5] points after 6 months. In group 2, scores on Part III of the UPDRS after 1 month were 29[14;48] points and after 6 months were 34[13;42] points. The effectiveness of neuromodulation on the correction of motor symptoms in both groups after 1 month, no statistically significant difference was found (pm-w=0.89), as well as 6 months after the surgical intervention (pm-w=0.44).
Conclusion: No statistically significant differences in the effectiveness of neuromodulation on the overall assessment of motor symptoms of the disease were revealed when performing electrode implantation in the STN with MAC and under GA. More frequent deviation of the electrode trajectory when performing surgical intervention with MAC is associated with intraoperative correction based on the results of neuromonitoring.
References: [1] C. Lau, C. Zhu, V. Tang, A. Chan, K. Ma, P. Kan, A. Ng, J. Yeung, L. Cheung, V. Hui, D. Chan, D. Chan, W. Poon, V. Mok. Comparing the outcome under General Anaesthesia (GA) and Monitored Anesthesia Care (MAC) of Subthalamic Nucleus (STN) – Deep Brain Stimulation (DBS) Surgery for Parkinson’s Disease (PD) in Hong Kong – A single center experience [abstract]. Mov Disord. 2023; 38 (suppl 1).
[2] C. Swan, J. Mazza, V. Palakuzhy, M. Wedding, S. Ramos, N. Patel, S. Sani. A retrospective comparison of functional and quality of life outcomes in DBS patients implanted via awake or asleep surgery: the Rush University Medical Center experience [abstract]. Mov Disord.
To cite this abstract in AMA style:
V. Bayarchyk, A. Buniak. Evaluation of the results of neuromodulation of the Subthalamic Nucleus (STN) in patients with Parkinson’s Disease (PD) depending on the anesthesia used during stereotactic electrode implantation. [abstract]. Mov Disord. 2024; 39 (suppl 1). https://www.mdsabstracts.org/abstract/evaluation-of-the-results-of-neuromodulation-of-the-subthalamic-nucleus-stn-in-patients-with-parkinsons-disease-pd-depending-on-the-anesthesia-used-during-stereotactic-electrode-implantation/. Accessed October 5, 2024.« Back to 2024 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/evaluation-of-the-results-of-neuromodulation-of-the-subthalamic-nucleus-stn-in-patients-with-parkinsons-disease-pd-depending-on-the-anesthesia-used-during-stereotactic-electrode-implantation/