Subthalamic deep brain stimulation after anesthetic inhalation in Parkinson disease: a preliminary study

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  • 1 Departments of Neurology,
  • 2 Anesthesiology, and
  • 3 Neurosurgery, Tzu Chi General Hospital, Tzu Chi University; and
  • 4 Institute of Aboriginal Health, Tzu Chi University, Hualien, Taiwan
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Object

The authors of this preliminary study investigated the outcome and feasibility of intraoperative microelectrode recording (MER) in patients with Parkinson disease (PD) undergoing deep brain stimulation of the subthalamic nucleus (STN) after anesthetic inhalation.

Methods

The authors conducted a retrospective analysis of 10 patients with PD who received a desflurane anesthetic during bilateral STN electrode implantation. The MERs were obtained as an intraoperative guide for final electrode implantation and the data were analyzed offline. The functional target coordinates of the electrodes were compared preoperatively with estimated target coordinates.

Results

Outcomes were evaluated using the Unified Parkinson's Disease Rating Scale 6 months after surgery. The mean improvement in total and motor Unified Parkinson's Disease Rating Scale scores was 54.27 ± 17.96% and 48.85 ± 16.97%, respectively. The mean STN neuronal firing rate was 29.7 ± 14.6 Hz. Typical neuronal firing patterns of the STN and substantia pars nigra reticulata were observed in each patient during surgery. Comparing the functional target coordinates, the z axis coordinates were noted to be significantly different between the pre- and postoperative coordinates.

Conclusions

The authors found that MER can be adequately performed while the patient receives a desflurane anesthetic, and the results can serve as a guide for STN electrode implantation. This may be a good alternative surgical method in patients with PD who are unable to tolerate deep brain stimulation surgery with local anesthesia.

Abbreviations used in this paper: DBS = deep brain stimulation; MAC = minimal alveolar concentration; MER = microelectrode recording; PD = Parkinson disease; SD = standard deviation; SNr = substantia pars nigra reticulata; STN = subthalamic nucleus; UPDRS = Unified Parkinson's Disease Rating Scale.

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Contributor Notes

Address correspondence to: Shin-Yuan Chen, M.D., M.Sc., Department of Neurosurgery, Tzu Chi General Hospital, 707, Sec. 3, Chung-Yang Road, Hualien, 970, Taiwan. email: william.sychen@msa.hinet.net.
  • 1

    Abosch A, , Hutchison WD, , Saint-Cyr JA, , Dostrovsky JO, & Lozano AM: Movement-related neurons of the subthalamic nucleus in patients with Parkinson disease. J Neurosurg 97:11671172, 2002

    • Search Google Scholar
    • Export Citation
  • 2

    Benazzouz A, , Breit S, , Koudsie A, , Pollak P, , Krack P, & Benabid AL: Intraoperative microrecordings of the subthalamic nucleus in Parkinson's disease. Mov Disord 17:3 Suppl S145S149, 2002

    • Search Google Scholar
    • Export Citation
  • 3

    Chen SY, , Lee CC, , Lin SH, , Hsin YL, , Lee TW, & Yen PS, : Microelectrode recording can be a good adjunct in magnetic resonance image-directed subthalamic nucleus deep brain stimulation for parkinsonism. Surg Neurol 65:253261, 2006

    • Search Google Scholar
    • Export Citation
  • 4

    Gross RE, , Krack P, , Rodriguez-Oroz MC, , Rezai AR, & Benabid AL: Electrophysiological mapping for the implantation of deep brain stimulators for Parkinson's disease and tremor. Mov Disord 21:14 Suppl S259S283, 2006

    • Search Google Scholar
    • Export Citation
  • 5

    Hertel F, , Züchner M, , Weimar I, , Gemmar P, , Noll B, & Bettag M, : Implantation of electrodes for deep brain stimulation of the subthalamic nucleus in advanced Parkinson's disease with the aid of intraoperative microrecording under general anesthesia. Neurosurgery 59:E1138, 2006

    • Search Google Scholar
    • Export Citation
  • 6

    Hughes AJ, , Daniel SE, , Kilford L, & Lees AJ: Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinicopathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181184, 1992

    • Search Google Scholar
    • Export Citation
  • 7

    Hutchison WD, , Allan RJ, , Opitz H, , Levy R, , Dostrovsky JO, & Lang AE, : Neurophysiological identification of the subthalamic nucleus in surgery for Parkinson's disease. Ann Neurol 44:622628, 1998

    • Search Google Scholar
    • Export Citation
  • 8

    Hutchison WD, , Lang AE, , Dostrovsky JO, & Lozano AM: Pallidal neuronal activity: implications for models of dystonia. Ann Neurol 53:480488, 2003

    • Search Google Scholar
    • Export Citation
  • 9

    Jou IM, , Chern TC, , Chen TY, & Tsai YC: Effects of desflurane on spinal somatosensory-evoked potentials and conductive spinal cord evoked potential. Spine 28:18451850, 2003

    • Search Google Scholar
    • Export Citation
  • 10

    Krack P, , Batir A, , Van Blercom N, , Chabardes S, , Fraix V, & Ardouin C, : Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 349:19251934, 2003

    • Search Google Scholar
    • Export Citation
  • 11

    Levy R, , Hutchison WD, , Lozano AM, & Dostrovsky JO: Highfrequency synchronization of neuronal activity in the subthalamic nucleus of parkinsonian patients with limb tremor. J Neurosci 20:77667775, 2000

    • Search Google Scholar
    • Export Citation
  • 12

    Liu X, , Ford-Dunn HL, , Hayward GN, , Nandi D, , Miall RC, & Aziz TZ, : The oscillatory activity in the parkinsonian subthalamic nucleus investigated using the macro-electrodes for deep brain stimulation. Clin Neurophysiol 113:16671672, 2002

    • Search Google Scholar
    • Export Citation
  • 13

    Maltete D, , Navarro S, , Welter ML, , Roche S, , Bonnet AM, & Houeto JL, : Subthalamic stimulation in Parkinson disease: with or without anesthesia?. Arch Neurol 61:390392, 2004

    • Search Google Scholar
    • Export Citation
  • 14

    Patel NK, , Heywood P, , O'Sullivan K, , Love S, & Gill SS: MRIdirected subthalamic nucleus surgery for Parkinson's disease. Stereotact Funct Neurosurg 78:132145, 2002

    • Search Google Scholar
    • Export Citation
  • 15

    Patel NK, , Plaha P, , O'Sullivan K, , McCarter R, , Heywood P, & Gill SS: MRI directed bilateral stimulation of the subthalamic nucleus in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry 74:16311637, 2003

    • Search Google Scholar
    • Export Citation
  • 16

    Priori A, , Egidi M, , Pesenti A, , Rohr M, , Rampini P, & Locatelli M, : Do intraoperative microrecordings improve subthalamic nucleus targeting in stereotactic neurosurgery for Parkinson's disease?. J Neurosurg Sci 47:5660, 2003

    • Search Google Scholar
    • Export Citation
  • 17

    Rodriguez-Oroz MC, , Rodriguez M, , Guridi J, , Mewes K, , Chockkman V, & Vitek J, : The subthalamic nucleus in Parkinson's disease: somatotopic organization and physiological characteristics. Brain 124:17771790, 2001

    • Search Google Scholar
    • Export Citation
  • 18

    Rodriguez-Oroz MC, , Zamarbide I, , Guridi J, , Palmero MR, & Obeso JA: Efficacy of deep brain stimulation of the subthalamic nucleus in Parkinson's disease 4 years after surgery: double blind and open label evaluation. J Neurol Neurosurg Psychiatry 75:13821385, 2004

    • Search Google Scholar
    • Export Citation
  • 19

    Romanelli P, , Heit G, , Hill B, , Kraus A, , Hastie T, & Bronte-Stewart H: Microelectrode recording revealing a somatotopic body map in the subthalamic nucleus in humans with Parkinson disease. J Neurosurg 100:611618, 2004

    • Search Google Scholar
    • Export Citation
  • 20

    Sanghera MK, , Grossman RG, , Kalhorn CG, , Hamilton WJ, , Ondo WG, & Jankovic J: Basal ganglia neuronal discharge in primary and secondary dystonia in patients undergoing pallidotomy. Neurosurgery 52:13581373, 2003

    • Search Google Scholar
    • Export Citation
  • 21

    Schüpbach WM, , Chastan N, , Welter ML, , Houeto JL, , Mesnage V, & Bonnet AM, : Stimulation of the subthalamic nucleus in Parkinson's disease: a 5 year follow up. J Neurol Neurosurg Psychiatry 76:16401644, 2005

    • Search Google Scholar
    • Export Citation
  • 22

    Steigerwald F, , Hinz L, , Pinsker MO, , Herzog J, , Stiller RU, & Kopper F, : Effect of propofol anesthesia on pallidal neuronal discharges in generalized dystonia. Neurosci Lett 386:156159, 2005

    • Search Google Scholar
    • Export Citation
  • 23

    Sterio D, , Zonenshayn M, , Mogilner A, , Rezai A, , Kiprovski K, & Kelly P, : Neurophysiological refinement of subthalamic nucleus targeting. Neurosurgery 50:5859, 2002

    • Search Google Scholar
    • Export Citation
  • 24

    Theodosopoulos PV, , Marks WJ, , Christine C, & Starr PA: Locations of movement-related cells in the human subthalamic nucleus in Parkinson's disease. Mov Disord 18:791798, 2003

    • Search Google Scholar
    • Export Citation

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