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Tinkhauser G, Pollo C, Debove I, Nowacki A, Krack P. Should asleep deep brain stimulation in Parkinson's disease be preferred over the awake approach? Pros. Swiss Med Wkly 2024; 154:3823. [PMID: 39137442 DOI: 10.57187/s.3823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
No abstract available.
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Affiliation(s)
- Gerd Tinkhauser
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Claudio Pollo
- Department of Neurosurgery, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Ines Debove
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andreas Nowacki
- Department of Neurosurgery, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Paul Krack
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
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2
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Swinford-Jackson SE, Pierce RC. Deep brain stimulation for psychostimulant use disorders. J Neural Transm (Vienna) 2024; 131:469-473. [PMID: 37823965 DOI: 10.1007/s00702-023-02706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
Safe and effective therapeutics for psychostimulant use disorders remain elusive. Deep brain stimulation (DBS), which is FDA-approved for other indications, is a promising candidate for treating severe substance use disorders. We examine the clinical and preclinical evidence for DBS of the nucleus accumbens as a possible therapeutic option for cocaine and methamphetamine use disorders. Limitations of the literature to date, including the lack of females included in studies evaluating the efficacy of DBS, and new strategies to optimize brain stimulation approaches are also discussed.
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Affiliation(s)
- Sarah E Swinford-Jackson
- Brain Health Institute and Department of Psychiatry, Rutgers University, 683 Hoes Lane West Room 160, Piscataway, NJ, 08854-5635, USA.
| | - R Christopher Pierce
- Brain Health Institute and Department of Psychiatry, Rutgers University, 683 Hoes Lane West Room 160, Piscataway, NJ, 08854-5635, USA
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Bishay AE, Lyons AT, Koester SW, Paulo DL, Liles C, Dambrino RJ, Feldman MJ, Ball TJ, Bick SK, Englot DJ, Chambless LB. Global Economic Evaluation of the Reported Costs of Deep Brain Stimulation. Stereotact Funct Neurosurg 2024; 102:257-274. [PMID: 38513625 PMCID: PMC11309055 DOI: 10.1159/000537865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Despite the known benefits of deep brain stimulation (DBS), the cost of the procedure can limit access and can vary widely. Our aim was to conduct a systematic review of the reported costs associated with DBS, as well as the variability in reporting cost-associated factors to ultimately increase patient access to this therapy. METHODS A systematic review of the literature for cost of DBS treatment was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Embase databases were queried. Olsen & Associates (OANDA) was used to convert all reported rates to USD. Cost was corrected for inflation using the US Bureau of Labor Statistics Inflation Calculator, correcting to April 2022. RESULTS Twenty-six articles on the cost of DBS surgery from 2001 to 2021 were included. The median number of patients across studies was 193, the mean reported age was 60.5 ± 5.6 years, and median female prevalence was 38.9%. The inflation- and currency-adjusted mean cost of the DBS device was USD 21,496.07 ± USD 8,944.16, the cost of surgery alone was USD 14,685.22 ± USD 8,479.66, the total cost of surgery was USD 40,942.85 ± USD 17,987.43, and the total cost of treatment until 1 year of follow-up was USD 47,632.27 ± USD 23,067.08. There were no differences in costs observed across surgical indication or country. CONCLUSION Our report describes the large variation in DBS costs and the manner of reporting costs. The current lack of standardization impedes productive discourse as comparisons are hindered by both geographic and chronological variations. Emphasis should be put on standardized reporting and analysis of reimbursement costs to better assess the variability of DBS-associated costs in order to make this procedure more cost-effective and address areas for improvement to increase patient access to DBS.
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Affiliation(s)
| | | | | | - Danika L. Paulo
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Campbell Liles
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert J. Dambrino
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael J. Feldman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tyler J. Ball
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah K. Bick
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dario J. Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lola B. Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Kesarwani R, Mahajan UV, Wang AS, Kilbane C, Shaikh AG, Miller JP, Sweet JA. Improved Side-Effect Stimulation Thresholds and Postoperative Transient Confusion With Asleep, Image-Guided Deep Brain Stimulation. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01042. [PMID: 38305427 DOI: 10.1227/ons.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/01/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Asleep, image-guided deep brain stimulation (DBS) is a modern alternative to awake, microelectrode recording (MER) guidance. Studies demonstrate comparable efficacy and complications between techniques, although some report lower stimulation thresholds for side effects with image guidance. In addition, few studies directly compare the risk of postoperative transient confusion (pTC) across techniques. The purpose of this study was to compare clinical efficacy, stimulation thresholds for side effects, and rates of pTC with MER-guided DBS vs intraoperative 3D-fluoroscopy (i3D-F) guidance in Parkinson's disease and essential tremor. METHODS Consecutive patients from 2006 to 2021 were identified from the departmental database and grouped as having either MER-guided DBS or i3D-F-guided DBS insertion. Directional leads were used once commercially available. Changes in Unified Parkinson's Disease Rating Scale (UPDRS)-III scores, levodopa equivalent daily dose, Fahn-Tolosa-Marin scores, and stimulation thresholds were assessed, as were rates of complications including pTC. RESULTS MER guidance was used to implant 487 electrodes (18 globus pallidus interna, GPi; 171 subthalamic nucleus; 76 ventrointermediate thalamus, VIM) in 265 patients. i3D-F guidance was used in 167 electrodes (19 GPi; 25 subthalamic nucleus; 41 VIM) in 85 patients. There were no significant differences in Unified Parkinson's Disease Rating III Scale, levodopa equivalent daily dose, or Fahn-Tolosa-Marin between groups. Stimulation thresholds for side effects were higher with i3D-F guidance in the subthalamic nucleus (MER, 2.80 mA ± 0.98; i3D-F, 3.46 mA ± 0.92; P = .002) and VIM (MER, 2.81 mA ± 1.00; i3D-F, 3.19 mA ± 1.03; P = .0018). Less pTC with i3D-F guidance (MER, 7.5%; i3D-F, 1.2%; P = .034) was also found. CONCLUSION Although clinical efficacy between MER-guided and i3D-F-guided DBS was comparable, thresholds for stimulation side effects were higher with i3D-F guidance and the rate of pTC was lower. This suggests that image-guided DBS may affect long-term side effects and pose a decreased risk of pTC.
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Affiliation(s)
- Rohit Kesarwani
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Current Affiliation: Meritas Health Neurosurgery, North Kansas City Hospital, North Kansas City, Missouri, USA
| | - Uma V Mahajan
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Alexander S Wang
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Camilla Kilbane
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Aasef G Shaikh
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- United States Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Jonathan P Miller
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jennifer A Sweet
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Olson MC, Shill H, Ponce F, Aslam S. Deep brain stimulation in PD: risk of complications, morbidity, and hospitalizations: a systematic review. Front Aging Neurosci 2023; 15:1258190. [PMID: 38046469 PMCID: PMC10690827 DOI: 10.3389/fnagi.2023.1258190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Parkinson's disease (PD) is a progressive and debilitating neurological disorder. While dopaminergic medication improves PD symptoms, continued management is complicated by continued symptom progression, increasing medication fluctuations, and medication-related dyskinesia. Deep brain stimulation (DBS) surgery is a well-accepted and widespread treatment often utilized to address these symptoms in advanced PD. However, DBS may also lead to complications requiring hospitalization. In addition, patients with PD and DBS may have specialized care needs during hospitalization. Methods This systematic review seeks to characterize the complications and risk of hospitalization following DBS surgery. Patient risk factors and modifications to DBS surgical techniques that may affect surgical risk are also discussed. Results It is found that, when candidates are carefully screened, DBS is a relatively low-risk procedure, but rate of hospitalization is somewhat increased for DBS patients. Discussion More research is needed to determine the relative influence of more advanced disease vs. DBS itself in increased rate of hospitalization, but education about DBS and PD is important to insure effective patient care within the hospital.
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Affiliation(s)
- Markey C. Olson
- Department of Neurology, Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
- Department of Neurosurgery, Barrow Brain and Spine, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Holly Shill
- Department of Neurology, Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Francisco Ponce
- Department of Neurosurgery, Barrow Brain and Spine, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Sana Aslam
- Department of Neurology, Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
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Lo C, Mane M, Kim JH, Berk M, Sharp RR, Lee KH, Yuen J. Treating addiction with deep brain stimulation: Ethical and legal considerations. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 113:103964. [PMID: 36774790 PMCID: PMC10023340 DOI: 10.1016/j.drugpo.2023.103964] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND The use of neuromodulation in the treatment of psychiatric conditions is controversial despite its lengthy history. This particularly applies to the use of invasive neuromodulation, such as deep brain stimulation (DBS), to treat substance use disorder (SUD) due to the considerable risks of the procedures. However, given the advances in DBS research and the shortcomings of current treatment modalities for addiction, off-label use and clinical trials are being implemented for the management of treatment-refractory patients. METHODS Here we conduct an ethical and legal analysis of DBS for SUD, referencing the four foundational principles of medical ethics and key legal concepts. RESULTS There are major concerns related to the capacity of a SUD patient to provide informed consent, as well as the risks and benefits of DBS compared to traditional treatment methods. In addition to ethical concerns, we explore potential legal issues that may arise from DBS in the treatment of addiction. These include the potential mandate of these procedures in the context of the criminalization of substance use, and the issue of familial consent in the decision-making process. Given the paucity of relevant clinical guidelines or legal cases, general medico-legal principles serve as the reference in making decisions about the responsible use of DBS as a treatment for addiction. CONCLUSIONS Given the rapidly increasing evidence for DBS as a treatment for SUD, it is an urgent imperative to consider the relevant key ethical and legal issues. Incorporating IDEAL (Idea, Development, Exploration, Assessment, Long-term follow-up) framework into future research in DBS is recommended to evaluate patient safety and ethical perspectives. With the broad criminalization of SUD across the globe, legal coercion of DBS is not impossible, especially if proven to be effective to treat SUD. It is advised for stakeholders to urgently consider incorporating DBS-related drug policies so that the potential benefits of DBS within the rights of people with SUD are not hindered by the lack of clinical guidance and legislations.
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Affiliation(s)
- Clara Lo
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; Macalester College, St. Paul, MN 55105, USA
| | - Mansee Mane
- University of Minnesota, Minneapolis, MN 55455, USA
| | - Jee Hyun Kim
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong VIC 3216, Australia
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong VIC 3216, Australia
| | - Richard R Sharp
- Biomedical Ethics Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; Department of Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Jason Yuen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong VIC 3216, Australia.
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Vesper J, Mainzer B, Senemmar F, Schnitzler A, Groiss SJ, Slotty PJ. Anesthesia for deep brain stimulation system implantation: adapted protocol for awake and asleep surgery using microelectrode recordings. Acta Neurochir (Wien) 2022; 164:1175-1182. [PMID: 35212799 PMCID: PMC8967743 DOI: 10.1007/s00701-021-05108-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/28/2021] [Indexed: 11/27/2022]
Abstract
Purpose Deep brain stimulation (DBS), an effective treatment for movement disorders, usually involves lead implantation while the patient is awake and sedated. Recently, there has been interest in performing the procedure under general anesthesia (asleep). This report of a consecutive cohort of DBS patients describes anesthesia protocols for both awake and asleep procedures. Methods Consecutive patients with Parkinson’s disease received subthalamic nucleus (STN) implants either moderately sedated or while intubated, using propofol and remifentanil. Microelectrode recordings were performed with up to five trajectories after discontinuing sedation in the awake group, or reducing sedation in the asleep group. Clinical outcome was compared between groups with the UPDRS III. Results The awake group (n = 17) received 3.5 mg/kg/h propofol and 11.6 μg/kg/h remifentanil. During recording, all anesthesia was stopped. The asleep group (n = 63) initially received 6.9 mg/kg/h propofol and 31.3 μg/kg/h remifentanil. During recording, this was reduced to 3.1 mg/kg/h propofol and 10.8 μg/kg/h remifentanil. Without parkinsonian medications or stimulation, 3-month UPDRS III ratings (ns = 16 and 52) were 40.8 in the awake group and 41.4 in the asleep group. Without medications but with stimulation turned on, ratings improved to 26.5 in the awake group and 26.3 in the asleep group. With both medications and stimulation, ratings improved further to 17.6 in the awake group and 15.3 in the asleep group. All within-group improvements from the off/off condition were statistically significant (all ps < 0.01). The degree of improvement with stimulation, with or without medications, was not significantly different in the awake vs. asleep groups (ps > 0.05). Conclusion The above anesthesia protocols make possible an asleep implant procedure that can incorporate sufficient microelectrode recording. Together, this may increase patient comfort and improve clinical outcomes.
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Affiliation(s)
- Jan Vesper
- Department of Functional Neurosurgery and Stereotaxy, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Bernd Mainzer
- Department of Anesthesia and Intensive Care Medicine, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Farhad Senemmar
- Department of Neurology & Institute for Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Alfons Schnitzler
- Department of Neurology & Institute for Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefan Jun Groiss
- Department of Neurology & Institute for Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp J Slotty
- Department of Functional Neurosurgery and Stereotaxy, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
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Engelhardt J, Caire F, Damon-Perrière N, Guehl D, Branchard O, Auzou N, Tison F, Meissner WG, Krim E, Bannier S, Bénard A, Sitta R, Fontaine D, Hoarau X, Burbaud P, Cuny E. A Phase 2 Randomized Trial of Asleep versus Awake Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease. Stereotact Funct Neurosurg 2020; 99:230-240. [PMID: 33254172 DOI: 10.1159/000511424] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Asleep deep brain stimulation (DBS) for Parkinson's disease (PD) is being performed more frequently; however, motor outcomes and safety of asleep DBS have never been assessed in a prospective randomized trial. METHODS We conducted a prospective, randomized, noncomparative trial to assess the motor outcomes of asleep DBS. Leads were implanted in the subthalamic nucleus (STN) according to probabilistic stereotactic coordinates with a surgical robot under O-arm© imaging guidance under either general anesthesia without microelectrode recordings (MER) (20 patients, asleep group) or local anesthesia with MER and clinical testing (9 patients, awake group). RESULTS The mean motor improvement rates on the Unified Parkinson's Disease Rating Scale Part III (UPDRS-3) between OFF and ON stimulation without medication were 52.3% (95% CI: 45.4-59.2%) in the asleep group and 47.0% (95% CI: 23.8-70.2%) in the awake group, 6 months after surgery. Except for a subcutaneous hematoma, we did not observe any complications related to the surgery. Three patients (33%) in the awake group and 8 in the asleep group (40%) had at least one side effect potentially linked with neurostimulation. CONCLUSIONS Owing to its randomized design, our study supports the hypothesis that motor outcomes after asleep STN-DBS in PD may be noninferior to the standard awake procedure.
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Affiliation(s)
- Julien Engelhardt
- CHU de Bordeaux, Service de Neurochirurgie B, Bordeaux, France, .,Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, Bordeaux, France, .,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France,
| | - François Caire
- Université de Limoges, CNRS, XLIM, UMR7252, Limoges, France.,CHU de Limoges, Service de Neurochirurgie, Limoges, France
| | - Nathalie Damon-Perrière
- Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service d'explorations Fonctionnelles du Système Nerveux, Bordeaux, France
| | - Dominique Guehl
- Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service d'explorations Fonctionnelles du Système Nerveux, Bordeaux, France
| | | | - Nicolas Auzou
- CHU de Bordeaux, Service de Neurologie, Bordeaux, France.,Laboratoire de Psychologie, Université de Bordeaux, Bordeaux, France
| | - François Tison
- Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service de Neurologie, Bordeaux, France
| | - Wassilios G Meissner
- Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service de Neurologie, Bordeaux, France
| | - Elsa Krim
- CH de Pau, Service de Neurologie, Pau, France
| | | | - Antoine Bénard
- CHU Bordeaux, Pôle de Santé Publique, Clinical Epidemiology Unit (USMR), Bordeaux, France
| | - Rémi Sitta
- CHU Bordeaux, Pôle de Santé Publique, Clinical Epidemiology Unit (USMR), Bordeaux, France
| | - Denys Fontaine
- CHU de Nice, Service de Neurochirurgie, Nice, France.,Université Côte d'Azur, Nice, France
| | - Xavier Hoarau
- Polyclinique de Navarre, Service de Neurochirurgie, Pau, France
| | - Pierre Burbaud
- Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service d'explorations Fonctionnelles du Système Nerveux, Bordeaux, France
| | - Emmanuel Cuny
- CHU de Bordeaux, Service de Neurochirurgie B, Bordeaux, France.,Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
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9
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Jin H, Gong S, Tao Y, Huo H, Sun X, Song D, Xu M, Xu Z, Liu Y, Wang S, Yuan L, Wang T, Song W, Pan H. A comparative study of asleep and awake deep brain stimulation robot-assisted surgery for Parkinson's disease. NPJ PARKINSONS DISEASE 2020; 6:27. [PMID: 33083521 PMCID: PMC7536209 DOI: 10.1038/s41531-020-00130-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 09/02/2020] [Indexed: 01/13/2023]
Abstract
To compare the differences between asleep and awake robot-assisted deep brain stimulation (DBS) surgery for Parkinson’s Disease (PD), we conducted this retrospective cohort study included 153 PD patients undergoing bilateral robot-assisted DBS from June 2017 to August 2019, of which 58 cases were performed under general anesthesia (GA) and 95 cases under local anesthesia (LA). Procedure duration, stimulation parameters, electrode implantation accuracy, intracranial air, intraoperative electrophysiological signal length, complications, and Unified PD Rating Scale (UPDRS) measurements were recorded and compared. The clinical evaluation was conducted by two raters who were blinded to the choice of anesthesia. Procedure duration was significantly shorter in the GA group, while on stimulation off medication motor scores (UPDRS-III) were significantly improved in both the GA and LA group. ANCOVA covariated for the baseline UPDRS-III and levodopa challenge exhibited no significant differences. In terms of amplitude, frequency, and pulse width, the stimulation parameters used for DBS power-on were similar. There were no significant differences in electrode implantation accuracy, intraoperative electrophysiological signal length, or intracerebral hemorrhage (no occurrences in either group). The pneumocephalus volume was significantly smaller in the GA group. Six patients exhibited transient throat discomfort associated with tracheal intubation in the GA group. The occurrence of surgical incision infection was similar in both groups. Compared with the awake group, the asleep group exhibited a shorter procedure duration with a similar electrode implantation accuracy and short-term motor improvement. Robot-assisted asleep DBS surgery is a promising surgical method for PD.
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Affiliation(s)
- Hai Jin
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Shun Gong
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Yingqun Tao
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Hua Huo
- Department of Clinical Trail Management Agency, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Xiao Sun
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Dandan Song
- Department of Anesthesia, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Ming Xu
- Department of Anesthesia, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Zhaozhu Xu
- Department of Anesthesia, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Yang Liu
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Shimiao Wang
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Lijia Yuan
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Tingting Wang
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - Weilong Song
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
| | - He Pan
- Department of Neurosurgery, The General Hospital of Northern Theater Command, 83 Wenhua Road, 110016 Shenyang, China
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10
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Park HR, Lim YH, Song EJ, Lee JM, Park K, Park KH, Lee WW, Kim HJ, Jeon B, Paek SH. Bilateral Subthalamic Nucleus Deep Brain Stimulation under General Anesthesia: Literature Review and Single Center Experience. J Clin Med 2020; 9:jcm9093044. [PMID: 32967337 PMCID: PMC7564882 DOI: 10.3390/jcm9093044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/13/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
Bilateral subthalamic nucleus (STN) Deep brain stimulation (DBS) is a well-established treatment in patients with Parkinson's disease (PD). Traditionally, STN DBS for PD is performed by using microelectrode recording (MER) and/or intraoperative macrostimulation under local anesthesia (LA). However, many patients cannot tolerate the long operation time under LA without medication. In addition, it cannot be even be performed on PD patients with poor physical and neurological condition. Recently, it has been reported that STN DBS under general anesthesia (GA) can be successfully performed due to the feasible MER under GA, as well as the technical advancement in direct targeting and intraoperative imaging. The authors reviewed the previously published literature on STN DBS under GA using intraoperative imaging and MER, focused on discussing the technique, clinical outcome, and the complication, as well as introducing our single-center experience. Based on the reports of previously published studies and ours, GA did not interfere with the MER signal from STN. STN DBS under GA without intraoperative stimulation shows similar or better clinical outcome without any additional complication compared to STN DBS under LA. Long-term follow-up with a large number of the patients would be necessary to validate the safety and efficacy of STN DBS under GA.
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Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea;
| | - Yong Hoon Lim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea; (Y.H.L.); (E.J.S.)
| | - Eun Jin Song
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea; (Y.H.L.); (E.J.S.)
| | - Jae Meen Lee
- Department of Neurosurgery, Pusan National University Hospital, Busan 49241, Korea;
| | - Kawngwoo Park
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon 21565, Korea;
| | - Kwang Hyon Park
- Department of Neurosurgery, Chuungnam National University Sejong Hospital, Sejong 30099, Korea;
| | - Woong-Woo Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea;
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea; (H.-J.K.); (B.J.)
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea; (H.-J.K.); (B.J.)
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea; (Y.H.L.); (E.J.S.)
- Correspondence: ; Tel.: +82-22-072-2876
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Wang J, Ponce FA, Tao J, Yu HM, Liu JY, Wang YJ, Luan GM, Ou SW. Comparison of Awake and Asleep Deep Brain Stimulation for Parkinson's Disease: A Detailed Analysis Through Literature Review. Neuromodulation 2019; 23:444-450. [PMID: 31830772 DOI: 10.1111/ner.13061] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/22/2019] [Accepted: 09/11/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Deep brain stimulation (DBS) for Parkinson's disease (PD) has been applied to clinic for approximately 30 years. The goal of this review is to explore the similarities and differences between "awake" and "asleep" DBS techniques. METHODS A comprehensive literature review was carried out to identify relevant studies and review articles describing applications of "awake" or "asleep" DBS for Parkinson's disease. The surgical procedures, clinical outcomes, costs and complications of each technique were compared in detail through literature review. RESULTS The surgical procedures of awake and asleep DBS surgeries rely upon different methods for verification of intended target acquisition. The existing research results demonstrated that the stereotactic targeting accuracy of lead placement obtained by either method is reliable. There were no significant differences in clinical outcomes, costs, or complications between the two techniques. CONCLUSION The surgical and clinical outcomes of asleep DBS for PD are comparable to those of awake DBS.
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Affiliation(s)
- Jun Wang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jun Tao
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Hong-Mei Yu
- Department of Neurology, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Ji-Yuan Liu
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Yun-Jie Wang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Guo-Ming Luan
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, P. R., China
| | - Shao-Wu Ou
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
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VanSickle D, Volk V, Freeman P, Henry J, Baldwin M, Fitzpatrick CK. Electrode Placement Accuracy in Robot-Assisted Asleep Deep Brain Stimulation. Ann Biomed Eng 2019; 47:1212-1222. [PMID: 30796551 DOI: 10.1007/s10439-019-02230-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/13/2019] [Indexed: 12/20/2022]
Abstract
Deep brain stimulation (DBS) involves the implantation of electrodes into specific central brain structures for the treatment of Parkinson's disease. Image guidance and robot-assisted techniques have been developed to assist in the accuracy of electrode placement. Traditional DBS is performed with the patient awake and utilizes microelectrode recording for feedback, which yields lengthy operating room times. Asleep DBS procedures use imaging techniques to verify electrode placement. The objective of this study is to demonstrate the validity of an asleep robot-assisted DBS procedure that utilizes intraoperative imaging techniques for precise electrode placement in a large, inclusive cohort. Preoperative magnetic resonance imaging (MRI) was used to plan the surgical procedure for the 128 patients that underwent asleep DBS. During the surgery, robot assistance was used during the implantation of the electrodes. To verify electrode placement, intraoperative CT scans were fused with the preoperative MRIs. The mean radial error of all final electrode placements is 0.85 ± 0.38 mm. MRI-CT fusion error is 0.64 ± 0.40 mm. The average operating room time for bilateral and unilateral implantations are 139.3 ± 34.7 and 115.4 ± 42.1 min, respectively. This study shows the validity of the presented asleep DBS procedure using robot assistance and intraoperative CT verification for accurate electrode placement with shorter operating room times.
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Affiliation(s)
- David VanSickle
- Littleton Adventist Hospital, Centura Health, Littleton, CO, USA.,Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, MS-2085, Boise, ID, 83725-2085, USA
| | - Victoria Volk
- Micron School of Materials Science and Engineering, Boise State University, Boise, ID, USA.,Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, MS-2085, Boise, ID, 83725-2085, USA
| | - Patricia Freeman
- Littleton Adventist Hospital, Centura Health, Littleton, CO, USA
| | - Jamie Henry
- Littleton Adventist Hospital, Centura Health, Littleton, CO, USA
| | - Meghan Baldwin
- Littleton Adventist Hospital, Centura Health, Littleton, CO, USA
| | - Clare K Fitzpatrick
- Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, MS-2085, Boise, ID, 83725-2085, USA.
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Walker HC, Faulk J, Rahman AF, Gonzalez CL, Roush P, Nakhmani A, Crowell JL, Guthrie BL. Awake Testing during Deep Brain Stimulation Surgery Predicts Postoperative Stimulation Side Effect Thresholds. Brain Sci 2019; 9:brainsci9020044. [PMID: 30781641 PMCID: PMC6407022 DOI: 10.3390/brainsci9020044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 11/16/2022] Open
Abstract
Despite substantial experience with deep brain stimulation for movement disorders and recent interest in electrode targeting under general anesthesia, little is known about whether awake macrostimulation during electrode targeting predicts postoperative side effects from stimulation. We hypothesized that intraoperative awake macrostimulation with the newly implanted DBS lead predicts dose-limiting side effects during device activation in clinic. We reviewed 384 electrode implants for movement disorders, characterized the presence or absence of stimulus amplitude thresholds for dose-limiting DBS side effects during surgery, and measured their predictive value for side effects during device activation in clinic with odds ratios ±95% confidence intervals. We also estimated associations between voltage thresholds for side effects within participants. Intraoperative clinical response to macrostimulation led to adjustments in DBS electrode position during surgery in 37.5% of cases (31.0% adjustment of lead depth, 18.2% new trajectory, or 11.7% both). Within and across targets and disease states, dose-limiting stimulation side effects from the final electrode position in surgery predict postoperative side effects, and side effect thresholds in clinic occur at lower stimulus amplitudes versus those encountered in surgery. In conclusion, awake clinical testing during DBS targeting impacts surgical decision-making and predicts dose-limiting side effects during subsequent device activation.
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Affiliation(s)
- Harrison C Walker
- Departments of Neurology and Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Jesse Faulk
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Akm Fazlur Rahman
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Christopher L Gonzalez
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Patrick Roush
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Arie Nakhmani
- Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Jason L Crowell
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Barton L Guthrie
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Kremer NI, Oterdoom DLM, van Laar PJ, Piña-Fuentes D, van Laar T, Drost G, van Hulzen ALJ, van Dijk JMC. Accuracy of Intraoperative Computed Tomography in Deep Brain Stimulation-A Prospective Noninferiority Study. Neuromodulation 2019; 22:472-477. [PMID: 30629330 PMCID: PMC6618091 DOI: 10.1111/ner.12918] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/04/2018] [Accepted: 11/30/2018] [Indexed: 01/09/2023]
Abstract
Introduction Clinical response to deep brain stimulation (DBS) strongly depends on the appropriate placement of the electrode in the targeted structure. Postoperative MRI is recognized as the gold standard to verify the DBS‐electrode position in relation to the intended anatomical target. However, intraoperative computed tomography (iCT) might be a feasible alternative to MRI. Materials and Methods In this prospective noninferiority study, we compared iCT with postoperative MRI (24‐72 hours after surgery) in 29 consecutive patients undergoing placement of 58 DBS electrodes. The primary outcome was defined as the difference in Euclidean distance between lead tip coordinates as determined on both imaging modalities, using the lead tip depicted on MRI as reference. Secondary outcomes were difference in radial error and depth, as well as difference in accuracy relative to target. Results The mean difference between the lead tips was 0.98 ± 0.49 mm (0.97 ± 0.47 mm for the left‐sided electrodes and 1.00 ± 0.53 mm for the right‐sided electrodes). The upper confidence interval (95% CI, 0.851 to 1.112) did not exceed the noninferiority margin established. The average radial error between lead tips was 0.74 ± 0.48 mm and the average depth error was determined to be 0.53 ± 0.40 mm. The linear Deming regression indicated a good agreement between both imaging modalities regarding accuracy relative to target. Conclusions Intraoperative CT is noninferior to MRI for the verification of the DBS‐electrode position. CT and MRI have their specific benefits, but both should be considered equally suitable for assessing accuracy.
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Affiliation(s)
- Naomi I Kremer
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D L Marinus Oterdoom
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Jan van Laar
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dan Piña-Fuentes
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea Drost
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjen L J van Hulzen
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Rumalla K, Smith KA, Follett KA, Nazzaro JM, Arnold PM. Rates, causes, risk factors, and outcomes of readmission following deep brain stimulation for movement disorders: Analysis of the U.S. Nationwide Readmissions Database. Clin Neurol Neurosurg 2018; 171:129-134. [DOI: 10.1016/j.clineuro.2018.06.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/28/2018] [Accepted: 06/09/2018] [Indexed: 12/21/2022]
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16
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Blasberg F, Wojtecki L, Elben S, Slotty PJ, Vesper J, Schnitzler A, Groiss SJ. Comparison of Awake vs. Asleep Surgery for Subthalamic Deep Brain Stimulation in Parkinson's Disease. Neuromodulation 2018. [PMID: 29532560 DOI: 10.1111/ner.12766] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) surgery for Parkinson's disease (PD) is usually performed as awake surgery allowing sufficient intraoperative testing. Recently, outcomes after asleep surgery have been assumed comparable. However, direct comparisons between awake and asleep surgery are scarce. OBJECTIVE To investigate the difference between awake and asleep surgery comparing motor and nonmotor outcome after subthalamic nucleus (STN)-DBS in a large single center PD population. METHODS Ninety-six patients were retrospectively matched pairwise (48 asleep and 48 awake) and compared regarding improvement of Unified PD Rating Scale Motor Score (UPDRS-III), cognitive function, Levodopa-equivalent-daily-dose (LEDD), stimulation amplitudes, side effects, surgery duration, and complication rates. Routine testing took place at three months and one year postoperatively. RESULTS Chronic DBS effects (UPDRS-III without medication and with stimulation on [OFF/ON]) significantly improved UPDRS-III only after awake surgery at three months and in both groups one year postoperatively. Acute effects (percentage UPDRS-III reduction after activation of stimulation) were also significantly better after awake surgery at three months but not at one year compared to asleep surgery. UPDRS-III subitems "freezing" and "speech" were significantly worse after asleep surgery at three months and one year, respectively. LEDD was significantly lower after awake surgery only one week postoperatively. The other measures did not differ between groups. CONCLUSIONS Overall motor function improved faster in the awake surgery group, but the difference ceased after one year. However, axial subitems were worse in the asleep surgery group suggesting that worsening of axial symptoms was risked improving overall motor function. Awake surgery still seems advantageous for STN-DBS in PD, although asleep surgery may be considered with lower threshold in patients not suitable for awake surgery.
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Affiliation(s)
- Fabian Blasberg
- Department of Neurology & Institute for Clinical Neuroscience and Medical Psychology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Lars Wojtecki
- Department of Neurology & Institute for Clinical Neuroscience and Medical Psychology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Saskia Elben
- Department of Neurology & Institute for Clinical Neuroscience and Medical Psychology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Jörg Slotty
- Department of Functional Neurosurgery and Stereotaxy, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Jan Vesper
- Department of Functional Neurosurgery and Stereotaxy, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Alfons Schnitzler
- Department of Neurology & Institute for Clinical Neuroscience and Medical Psychology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefan Jun Groiss
- Department of Neurology & Institute for Clinical Neuroscience and Medical Psychology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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Abstract
INTRODUCTION Essential tremor is the most common form of pathologic tremor. Surgical therapies disrupt tremorogenic oscillation in the cerebellothalamocortical pathway and are capable of abolishing severe tremor that is refractory to available pharmacotherapies. Surgical methods are raspidly improving and are the subject of this review. Areas covered: A PubMed search on 18 January 2018 using the query essential tremor AND surgery produced 839 abstracts. 379 papers were selected for review of the methods, efficacy, safety and expense of stereotactic deep brain stimulation (DBS), stereotactic radiosurgery (SRS), focused ultrasound (FUS) ablation, and radiofrequency ablation of the cerebellothalamocortical pathway. Expert commentary: DBS and SRS, FUS and radiofrequency ablations are capable of reducing upper extremity tremor by more than 80% and are far more effective than any available drug. The main research questions at this time are: 1) the relative safety, efficacy, and expense of DBS, SRS, and FUS performed unilaterally and bilaterally; 2) the relative safety and efficacy of thalamic versus subthalamic targeting; 3) the relative safety and efficacy of atlas-based versus direct imaging tractography-based anatomical targeting; and 4) the need for intraoperative microelectrode recordings and macroelectrode stimulation in awake patients to identify the optimum anatomical target. Randomized controlled trials are needed.
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Affiliation(s)
- Rodger J Elble
- a Neuroscience Institute , Southern Illinois University School of Medicine , Springfield , Illinois , USA
| | - Ludy Shih
- b Department of Neurology , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , Massachusetts USA
| | - Jeffrey W Cozzens
- a Neuroscience Institute , Southern Illinois University School of Medicine , Springfield , Illinois , USA
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Krishna V, Sammartino F, Rezai AR. The Use of New Surgical Technologies for Deep Brain Stimulation. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brodsky MA, Anderson S, Murchison C, Seier M, Wilhelm J, Vederman A, Burchiel KJ. Clinical outcomes of asleep vs awake deep brain stimulation for Parkinson disease. Neurology 2017; 89:1944-1950. [DOI: 10.1212/wnl.0000000000004630] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 08/04/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:To compare motor and nonmotor outcomes at 6 months of asleep deep brain stimulation (DBS) for Parkinson disease (PD) using intraoperative imaging guidance to confirm electrode placement vs awake DBS using microelectrode recording to confirm electrode placement.Methods:DBS candidates with PD referred to Oregon Health & Science University underwent asleep DBS with imaging guidance. Six-month outcomes were compared to those of patients who previously underwent awake DBS by the same surgeon and center. Assessments included an “off”-levodopa Unified Parkinson’s Disease Rating Scale (UPDRS) II and III, the 39-item Parkinson's Disease Questionnaire, motor diaries, and speech fluency.Results:Thirty participants underwent asleep DBS and 39 underwent awake DBS. No difference was observed in improvement of UPDRS III (+14.8 ± 8.9 vs +17.6 ± 12.3 points, p = 0.19) or UPDRS II (+9.3 ± 2.7 vs +7.4 ± 5.8 points, p = 0.16). Improvement in “on” time without dyskinesia was superior in asleep DBS (+6.4 ± 3.0 h/d vs +1.7 ± 1.2 h/d, p = 0.002). Quality of life scores improved in both groups (+18.8 ± 9.4 in awake, +8.9 ± 11.5 in asleep). Improvement in summary index (p = 0.004) and subscores for cognition (p = 0.011) and communication (p < 0.001) were superior in asleep DBS. Speech outcomes were superior in asleep DBS, both in category (+2.77 ± 4.3 points vs −6.31 ± 9.7 points (p = 0.0012) and phonemic fluency (+1.0 ± 8.2 points vs −5.5 ± 9.6 points, p = 0.038).Conclusions:Asleep DBS for PD improved motor outcomes over 6 months on par with or better than awake DBS, was superior with regard to speech fluency and quality of life, and should be an option considered for all patients who are candidates for this treatment.Clinicaltrials.gov identifier:NCT01703598.Classification of evidence:This study provides Class III evidence that for patients with PD undergoing DBS, asleep intraoperative CT imaging–guided implantation is not significantly different from awake microelectrode recording–guided implantation in improving motor outcomes at 6 months.
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Oravec CS, Motiwala M, Reed K, Kondziolka D, Barker FG, Michael LM, Klimo P. Big Data Research in Neurosurgery: A Critical Look at this Popular New Study Design. Neurosurgery 2017; 82:728-746. [DOI: 10.1093/neuros/nyx328] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/17/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Chesney S Oravec
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kevin Reed
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Fred G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
- Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, Tennessee
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Comparison of Globus Pallidus Interna and Subthalamic Nucleus in Deep Brain Stimulation for Parkinson Disease: An Institutional Experience and Review. PARKINSONS DISEASE 2017; 2017:3410820. [PMID: 28706748 PMCID: PMC5494569 DOI: 10.1155/2017/3410820] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/07/2017] [Indexed: 01/17/2023]
Abstract
Deep Brain Stimulation (DBS) has revolutionized the lives of patients of Parkinson disease, offering therapeutic options to those not benefiting entirely from medications alone. With its proven track record of outperforming the best medical management, the goal is to unlock the full potential of this therapy. Currently, the Globus Pallidus Interna (GPi) and Subthalamic Nucleus (STN) are both viable targets for DBS, and the choice of site should focus on the constellation of symptoms, both motor and nonmotor, which are key determinants to quality of life. Our article sheds light on the specific advantages and drawbacks of the two sites, highlighting the need for matching the inherent properties of a target with specific desired effects in patients. UT Southwestern Medical Center has a robust and constantly evolving DBS program and the narrative from our center provides invaluable insight into the practical realities of DBS. The ultimate decision in selecting a DBS target is complex, ideally made by a multidisciplinary team, tailored towards each patient's profile and their expectations, by drawing upon scientific evidence coupled with experience. Ongoing research is expanding our knowledge base, which should be dynamically incorporated into an institute's DBS paradigm to ensure that patients receive the optimal therapy.
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Chen T, Mirzadeh Z, Lambert M, Gonzalez O, Moran A, Shetter AG, Ponce FA. Cost of Deep Brain Stimulation Infection Resulting in Explantation. Stereotact Funct Neurosurg 2017; 95:117-124. [DOI: 10.1159/000457964] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 01/18/2017] [Indexed: 01/30/2023]
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Eseonu CI, Rincon-Torroella J, ReFaey K, Quiñones-Hinojosa A. The Cost of Brain Surgery: Awake vs Asleep Craniotomy for Perirolandic Region Tumors. Neurosurgery 2017; 81:307-314. [DOI: 10.1093/neuros/nyx022] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 02/15/2017] [Indexed: 11/14/2022] Open
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Chen T, Mirzadeh Z, Chapple K, Lambert M, Ponce FA. Complication rates, lengths of stay, and readmission rates in "awake" and "asleep" deep brain simulation. J Neurosurg 2016; 127:360-369. [PMID: 27662532 DOI: 10.3171/2016.6.jns152946] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE As the number of deep brain stimulation (DBS) procedures performed under general anesthesia ("asleep" DBS) increases, it is more important to assess the rates of adverse events, inpatient lengths of stay (LOS), and 30-day readmission rates in patients undergoing these procedures compared with those in patients undergoing traditional "awake" DBS without general anesthesia. METHODS All patients in an institutional database who had undergone awake or asleep DBS procedures performed by a single surgeon between August 2011 and August 2014 were reviewed. Adverse events, inpatient LOS, and 30-day readmissions were analyzed. RESULTS A total of 490 electrodes were placed in 284 patients, of whom 126 (44.4%) underwent awake surgery and 158 (55.6%) underwent asleep surgery. The most frequent overall complication for the cohort was postoperative mental status change (13 patients [4.6%]), followed by hemorrhage (4 patients [1.4%]), seizure (4 patients [1.4%]), and hardware-related infection (3 patients [1.1%]). Mean LOS for all 284 patients was 1.19 ± 1.29 days (awake: 1.06 ± 0.46 days; asleep: 1.30 ± 1.67 days; p = 0.08). Overall, the 30-day readmission rate was 1.4% (1 awake patient, 3 asleep patients). There were no significant differences in complications, LOS, and 30-day readmissions between awake and asleep groups. CONCLUSIONS Both awake and asleep DBS can be performed safely with low complication rates. The authors found no significant differences between the 2 procedure groups in adverse events, inpatient LOS, and 30-day readmission rates.
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Affiliation(s)
- Tsinsue Chen
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Zaman Mirzadeh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kristina Chapple
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Margaret Lambert
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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