JAMA Neurology: Parkinson, deep brain stimulation, general anesthesia or local anesthesia, which one is better?

Deep brain stimulation (DBS) of the hypothalamic nucleus is an established and effective treatment method for patients with Parkinson's disease.
Despite the best medical treatment, there are still disabling motor response fluctuations
.

Electrode implantation is usually performed under local anesthesia, and intraoperative clinical observations are performed during the test stimulation period to determine the best position for electrode placement

This procedure is very burdensome for the patient, because despite the local anesthesia, they often feel pain during the placement of the stereotactic frame and during the operation
.

In addition, patients must endure long-term non-drug symptoms, while feeling anxious and exhausted due to clinical testing

This makes the trend of performing surgery under general anesthesia more and more obvious
.

Many centers have also cancelled microelectrode recordings, while many other centers continue to perform these recordings under general anesthesia

In this way, Rozemarije A.

Holewijn and others of the University of Amsterdam reported the results of a randomized clinical trial of general anesthesia and stereotactic local anesthesia (GALAXY), which aims to compare the subthalamic nucleus DBS operation under general anesthesia and local anesthesia For surgery, both groups used stereotactic frame-based MRI and microelectrode recording to determine the target

Intervention measures: DBS of the bilateral subthalamic nucleus was performed while the patients in one study group were asleep (under general anesthesia), and the patients in the other study group were awake
.

Both sets of studies used frame-based intraoperative microelectrode recording technology to perfect the final target position of the DBS lead

The DBS of the bilateral subthalamic nucleus was performed while the patients in one study group were asleep (under general anesthesia), and the patients in the other study group were awake

A total of 110 patients were randomly assigned to be awake (local anesthesia; n = 56; mean [SD] age, 60.

0 (7.
4) years; 40 [71%] men) or sleep (general anesthesia; n = 54; mean [SD] Age, 61.

103 participants completed the 6-month follow-up
.

The proportion of patients with adverse effects on the comprehensive score of cognition, emotion and behavior is 15 out of 52 (29%) in the awake state, and 11 out of 51 (22%) in the sleeping state (probability ratio, 0.
7[95%CI, 0.
3-1.
7])
.

The proportion of patients with adverse effects on the comprehensive score of cognition, emotion and behavior is 15 out of 52 (29%) in the awake state, and 11 out of 51 (22%) in the sleeping state (probability ratio, 0.
7[95%CI, 0.
3-1.
7])
.

There was no difference in the improvement of the sports examination scores of the Non-Medicated Dyskinesia Association Unified Parkinson’s Disease Rating Scale between the groups (waking group: average [SD], -27.
3 [17.
5] points; sleep group: average [SD], -25.
3 [14.
3] points; mean difference, -2.
0 [95% CI, -8.
1 to 4.
2])
.

The patient believes that the burden of sleep surgery is lighter, and the time is 26 minutes shorter than that of awake surgery
.

The important significance of this study is that it has found that there is no difference between the main results of sleep and waking DBS
.
Future large randomized clinical trials should examine some of the newer sleep-based DBS technologies, because this research is limited to frame-based microelectrode-guided surgery
.

There is no difference in the main results of sleeping and waking DBS

 

Original Source:
Holewijn RA, Verbaan D, van den Munckhof PM, et al.
General Anesthesia vs Local Anesthesia in Microelectrode Recording–Guided Deep-Brain Stimulation for Parkinson Disease : The GALAXY Randomized Clinical Trial.
JAMA Neurol.
Published online September 7, 2021 .
doi:10.
1001/jamaneurol.
2021.
2979

Anesthesia Local Anesthesia in VS General Recording microelectrode-Guided Deep-Brain Stimulation for Parkinson Disease JAMA in this message