Clinical outcomes following awake and asleep deep brain stimulation for Parkinson disease
| Autor: | Rohit Dhall, Alexander I. Tröster, Guillermo Moguel-Cobos, Tsinsue Chen, Francisco A. Ponce, Kristina Chapple, Zaman Mirzadeh, Holly A. Shill, Margaret Lambert |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Levodopa Deep brain stimulation Deep Brain Stimulation medicine.medical_treatment Unified Parkinson's disease rating scale Disease Anesthesia General Globus Pallidus Cohort Studies Part iii 03 medical and health sciences 0302 clinical medicine Quality of life Subthalamic Nucleus Rating scale Surveys and Questionnaires medicine Humans Wakefulness Aged business.industry Parkinson Disease General Medicine Middle Aged nervous system diseases Subthalamic nucleus Treatment Outcome 030220 oncology & carcinogenesis Anesthesia Quality of Life Female business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Journal of Neurosurgery. 130:109-120 |
| ISSN: | 1933-0693 0022-3085 |
| DOI: | 10.3171/2017.8.jns17883 |
| Popis: | OBJECTIVERecent studies have shown similar clinical outcomes between Parkinson disease (PD) patients treated with deep brain stimulation (DBS) under general anesthesia without microelectrode recording (MER), so-called “asleep” DBS, and historical cohorts undergoing “awake” DBS with MER guidance. However, few studies include internal controls. This study aims to compare clinical outcomes after globus pallidus internus (GPi) and subthalamic nucleus (STN) DBS using awake and asleep techniques at a single institution.METHODSPD patients undergoing awake or asleep bilateral GPi or STN DBS were prospectively monitored. The primary outcome measure was stimulation-induced change in motor function off medication 6 months postoperatively, measured using the Unified Parkinson’s Disease Rating Scale part III (UPDRS-III). Secondary outcomes included change in quality of life, measured by the 39-item Parkinson’s Disease Questionnaire (PDQ-39), change in levodopa equivalent daily dosage (LEDD), stereotactic accuracy, stimulation parameters, and adverse events.RESULTSSix-month outcome data were available for 133 patients treated over 45 months (78 GPi [16 awake, 62 asleep] and 55 STN [14 awake, 41 asleep]). UPDRS-III score improvement with stimulation did not differ between awake and asleep groups for GPi (awake, 20.8 points [38.5%]; asleep, 18.8 points [37.5%]; p = 0.45) or STN (awake, 21.6 points [40.3%]; asleep, 26.1 points [48.8%]; p = 0.20) targets. The percentage improvement in PDQ-39 and LEDD was similar for awake and asleep groups for both GPi (p = 0.80 and p = 0.54, respectively) and STN cohorts (p = 0.85 and p = 0.49, respectively).CONCLUSIONSIn PD patients, bilateral GPi and STN DBS using the asleep method resulted in motor, quality-of-life, and medication reduction outcomes that were comparable to those of the awake method. |
| Databáze: | OpenAIRE |
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