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.
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.
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.
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.
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"Regarding depression of the electrophysiological signals, there are few reports in the literature on the use of propofol for STN DBS (4, 5, 6, 17, 18). In addition, neuronal firing patterns are not well characterized and there are no prospective, randomized, blinded studies to compare their clinical outcome with that of an awaken technique. "
[Show abstract][Hide abstract] ABSTRACT: We investigated the effect of propofol and fentanyl on microelectrode recording (MER) and its clinical applicability during subthalamic nucleus (STN) deep brain stimulation (DBS) surgery. We analyzed 8 patients with Parkinson's disease, underwent bilateral STN DBS with MER. Their left sides were done under awake and then their right sides were done with a continuous infusion of propofol and fentanyl under local anesthesia. The electrode position was evaluated by preoperative MRI and postoperative CT. The clinical outcomes were assessed at six months after surgery. We isolated single unit activities from the left and the right side MERs. There was no significant difference in the mean firing rate between the left side MERs (38.7±16.8 spikes/sec, n=78) and the right side MERs (35.5±17.2 spikes/sec, n=66). The bursting pattern of spikes was more frequently observed in the right STN than in the left STN. All the electrode positions were within the STNs on both sides and the off-time Unified Parkinson's Disease Rating Scale part III scores at six months after surgery decreased by 67% of the preoperative level. In this study, a continuous infusion of propofol and fentanyl did not significantly interfere with the MER signals from the STN. The results of this study suggest that propofol and fentanyl can be used for STN DBS in patients with advanced Parkinson's disease improving the overall experience of the patients.
Full-text · Article · Sep 2014 · Journal of Korean Medical Science
"Microelectrode recordings from the STN nuclei during anesthesia have been more successful. The anesthetic techniques used have varied from monitored anesthesia care with or without sedation, analgesia or both along with conscious sedation with propofol and dexmedetomidine with no airway manipulation to general anesthesia with endotracheal intubation. "
[Show abstract][Hide abstract] ABSTRACT: Ablative intracranial surgery for Parkinson's disease has advanced to embedding electrodes into precise areas of the basal ganglia. Electrode implantation surgery, referred to as deep brain stimulation (DBS), is preferred in view of its reversibility, adjustability, and capability to be safely performed bilaterally. DBS is been increasingly used for other movement disorders, intractable tremors epilepsy, and sometimes chronic pain. Anesthesiologists need to amalgamate the knowledge of neuroanatomical structures and surgical techniques involved in placement of microelectrodes in defined cerebral target areas. Perioperative verbal communication with the patient during the procedure is quintessential and may attenuate the need for pharmacological agents. This review will endeavor to assimilate the present knowledge regarding the patient selection, available/practiced anesthesia regimens, and perioperative complications after our thorough search for literature published between 1991 and 2013.
No preview · Article · Aug 2014 · North American Journal of Medical Sciences
"Previous studies have reported that about 0.1–0.2% of the population is affected by PD (Chien et al., 2006). Several treatments have been reported to be effective, such as drugs like L-dopa and brain surgery with deep brain stimulation (Lin et al., 2008). "
[Show abstract][Hide abstract] ABSTRACT: Parkinson’s Disease (PD) is a common neurodegenerative disorder with progressive loss of dopaminergic and other sub-cortical neurons. Among various approaches, gait analysis is commonly used to help identify the biometric features of PD. There have been some studies to date on both the classification of PD and estimation of gait parameters. However, it is also important to construct a regression system that can evaluate the degree of abnormality in PD patients. In this paper, we intended to develop a PD gait regression model that is capable of predicting the severity of motor dysfunction from given gait image sequences. We used a model-free strategy and thus avoided the critical demands of segmentation and parameter estimation. Furthermore, we used linear discriminant analysis (LDA) to increase the feature efficiency by maximizing and minimizing the between- and within-group variations. Regression was also achieved by assessing the spatial and temporal information through classification and finally by using these two new indices for linear regression. According to the experiments, the outcomes significantly correlated with the sum of sub-scores from the Unified Parkinson’s Disease Rating Scale (UPDRS): motor examination section with r = 0.92 and 0.85 for training and testing, respectively, with p < 0.0001. Compared with conventional methods, our system provided a better evaluation of PD abnormality.
Full-text · Article · Jan 2012 · Expert Systems with Applications