Is awake physiological confirmation necessary for DBS treatment of Parkinson's disease today? A comparison of intraoperative imaging, physiology, and physiology imaging-guided DBS in the past decade

Yin, Zixiao; Luo, Yun; Jin, Yu; Yu, Yaqing; Zheng, Suyue; Duan, Jian; Xu, Renxu; Zhou, Dongwei; Hong, Tao; Lu, Guohui

doi:10.1016/j.brs.2019.03.006

Cited by 22 publications

(21 citation statements)

References 39 publications

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“…To detect significant differences in the baseline characteristics shown in Table 2 and compare all subgroup analyses of patients' tremor characteristics, laterality, and stimulation parameters, two-sample mean-comparison tests were performed in Stata/SE 12.0, which could calculate the P values based on the mean, standard deviation, and sample size. In addition, the potential predictive factors of the percentage of change in any objective TRS score were tested using a simple regression analysis in CMA software [17], and P ≤ 0:05 was defined as statistically significant. Publication bias was assessed using a funnel plot (Figure 1(b)) and Begg's test.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Adverse Effects of Deep Brain Stimulation on the Ventral Intermediate Nucleus in Patients with Essential Tremor

Luo

Liu

et al. 2020

Neural Plasticity

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Objective. This study was aimed at identifying the potential outcome predictors, comparing the efficacy in patients with different tremor characteristics, and summarizing the adverse effect rates (AERs) of deep brain stimulation on the ventral intermediate nucleus (VIM-DBS) for essential tremor (ET). Methods. An extensive search of articles published to date in 2019 was conducted, and two main aspects were analyzed. Improvement was calculated as a percentage of change in any objective tremor rating scale (TRS) and analyzed by subgroup analyses of patients’ tremor characteristics, laterality, and stimulation parameters. Furthermore, the AERs were analyzed as follows: the adverse effects (AEs) were classified as stimulation-related, surgical-related, or device-related effects. A simple regression analysis was used to identify the potential prognostic factors, and a two-sample mean-comparison test was used to verify the statistical significance of the subgroup analyses. Results. Forty-six articles involving 1714 patients were included in the meta-analysis. The pooled improvement in any objective TRS score was 61.3% (95% CI: 0.564-0.660) at the mean follow-up visit (20.0±17.3 months). The midline and extremity symptoms showed consistent improvement (P=0.440), and the results of the comparison of postural and kinetic tremor were the same (P=0.219). In addition, the improvement in rest tremor was similar to that in action tremor (OR=2.759, P=0.120). In the simple regression analysis, the preoperative Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS) scores and follow-up time were negatively correlated with the percentage change in any objective TRS score (P<0.05). The most common adverse event was dysarthria (10.5%), which is a stimulation-related AE (23.6%), while the rates of the surgical-related and device-related AEs were 6.4% and 11.5%, respectively. Conclusion. VIM-DBS is an efficient and safe surgical method in ET, and the efficacy was not affected by the body distribution of tremor, age at surgery, and disease duration. Lower preoperative FTM-TRS scores likely indicate greater improvement, and the effect of VIM-DBS declines over time.

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Section: Discussionmentioning

confidence: 99%

Outcomes and Adverse Effects of Deep Brain Stimulation on the Ventral Intermediate Nucleus in Patients with Essential Tremor

Luo

Liu

et al. 2020

Neural Plasticity

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“…In the last 30 years, awake surgery has been widely performed 7 , most often under LA with intraoperative test stimulation 3 . During awake surgery and without intraoperative imaging, neurosurgeons determine electrode placement by relying on electrophysiological typical signals and the patients' symptom relief without any side effects.…”

Section: Discussionmentioning

confidence: 99%

“…All patients underwent preoperative MRI (Siemens MAGNETOM Verio 3T Tim) and head contrast-enhanced CT using the parameters 7 before DBS surgery. Five metal markers (2023-VG, The ALCIS Company, Besancon, France) were fixed on the patients’ skulls before contrast-enhanced CT scanning.…”

Section: Methodsmentioning

confidence: 99%

A comparative study of asleep and awake deep brain stimulation robot-assisted surgery for Parkinson’s disease

Jin

Gong

Tao

et al. 2020

npj Parkinsons Dis.

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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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“…In this study, we did not observe the occurrence of DBS surgical complications during hospitalization, which may be explained by the younger candidates and surgical experience in the current study (36,37). The cost of awake surgery can be double or even triple the cost of asleep surgery (38), and the awake procedure is often accompanied by test stimulations, which further prolongs the duration of the procedure (39). Finally, awake mapping may be poorly tolerated by some candidates due to anxiety of brain surgery, medical comorbidities that preclude awake surgery (e.g., uncontrolled hypertension, obstructive sleep apnea, and claustrophobia), and severe dystonic posturing.…”

Section: Discussionmentioning

confidence: 99%

Asleep Deep Brain Stimulation in Patients With Isolated Dystonia: Stereotactic Accuracy, Efficacy, and Safety

Wang

Zhang

et al. 2021

Neuromodulation: Technology at the Neural Interface

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Is awake physiological confirmation necessary for DBS treatment of Parkinson's disease today? A comparison of intraoperative imaging, physiology, and physiology imaging-guided DBS in the past decade

Cited by 22 publications

References 39 publications

Outcomes and Adverse Effects of Deep Brain Stimulation on the Ventral Intermediate Nucleus in Patients with Essential Tremor

Outcomes and Adverse Effects of Deep Brain Stimulation on the Ventral Intermediate Nucleus in Patients with Essential Tremor

A comparative study of asleep and awake deep brain stimulation robot-assisted surgery for Parkinson’s disease

Asleep Deep Brain Stimulation in Patients With Isolated Dystonia: Stereotactic Accuracy, Efficacy, and Safety

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