Subthalamic Stimulation in Parkinson Disease

Maltête, David; Navarro, Soledad; Welter, Marie‐Laure; Roche, S.; Bonnet, Anne‐Marie; Houeto, Jean‐Luc; Mesnage, Valérie; Pidoux, B.; Dormont, Didier; Cornu, Philippe; Agid, Yves

doi:10.1001/archneur.61.3.390

Cited by 109 publications

(82 citation statements)

References 11 publications

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“…However, PD patients with obvious "off-medication" symptoms of anxiety, painful dystonia, and respiratory distress may not be good candidates for the lengthy tolerating the surgical procedures while awake [54][55][56][57]. In this section, we will report our own experience with general anesthesia during DBS surgery with MER and compare it with data from awake procedures (see Table 3).…”

Section: Anesthetic Considerations In Dbs: Awake Versus General Anestmentioning

confidence: 99%

“…Some patients with severe "off-medication" PD symptoms, such as major anxiety, poorly tolerated off-medication dystonia, or respiratory difficulties may refuse DBS or may be poor candidates for DBS in an awake state [55,57]. STN-DBS during a state of general anesthesia may be another choice for those patients with advanced PD for whom symptoms are difficult to control with medication only.…”

Section: General Anesthetic Dbs Proceduresmentioning

confidence: 99%

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Controversial Issues in Deep Brain Stimulation in Parkinson's Disease

Chen¹,

Tsai²,

Lin³

2011

Towards New Therapies for Parkinson's Disease

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Section: Anesthetic Considerations In Dbs: Awake Versus General Anestmentioning

confidence: 99%

Section: General Anesthetic Dbs Proceduresmentioning

confidence: 99%

Controversial Issues in Deep Brain Stimulation in Parkinson's Disease

Chen¹,

Tsai²,

Lin³

2011

Towards New Therapies for Parkinson's Disease

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“…The classic tremor triad in resting situation, muscular rigidity and bradykinesia are due to dopaminergic in the dense part. Patients may refer to procedures for the treatment of Parkinson's disease or for the treatment of other surgical diseases (Maltête et al, 2004). …”

mentioning

confidence: 99%

“…This method is also used to treat primary and secondary tremor. Currently, this method is used only for people who cannot adequately control the symptoms with drug (Maltête et al, 2004). Before surgery, MRI and CT scan are used to the precise identification of target location in the brain.…”

mentioning

confidence: 99%

“…In other 15 patients who had been matched for age and duration of the disease, due to severe anxiety and intolerance and proper co-operation, DBS was performed with general anaesthetic and intravenous Propofol injection (Maltête et al, 2004;Souter et al, 2007). In this study, it is clear that the severity of motor disability in both groups of patients has been clearly decreased, but the intensity of stimulation and the extent of residual motor disorder in the group under general anesthesia were greater, which indicates that stimulation of the subthalamic nucleus will have less accurate if clinical evaluation do not perform during surgery.…”

mentioning

confidence: 99%

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Comparison of the Effect of Dexmedetomidine and Propofol on Duration of Starting Tremor after Drug discontinuation in Parkinson's Patients under Deep Brain stimulation

Behnaz¹,

Ghasemi²,

Shabanpour³

2018

JMBR

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The purpose of this study was to compare the effects of Dexmedetomidine and Propofol on the duration of starting tremor after drug discontinuation in patients with Parkinson's disease under deep brain stimulation. In order to reach the research goals, 28 individuals with Parkinson's disease under deep brain stimulation were randomly assigned into two groups including Dexmedetomidine and Propofol that referring to Assistant Professor of Anesthesiology Taleghani Hospital in 2016. In the implementation phase. The following drugs were used: Dexmedetomidine (Precedex) with dose of 0.2-0.4 μ/kg/h and Propofol with doses of 20-30 mg bolus, and then 10-20 μ/kg/min infusion, with a control and preservation of BIS between 65 and 85, and also, RAMSY Sedation Score equal to 3. Locus of pin and the head scalp were anaesthetized with lidocaine drug. The total dose of local anaesthetic drugs was recorded at the end of the procedure. The interval time between drug discontinuation and start of tremor, and also, the time of emergence, was recorded as the time between relaxation and when the patient is able to cooperate for a neurological examination. All of the events during the operation and complications and complains of pain and restlessness were recorded. Moreover, the following cases were investigated Post-operative pain, vital signs, and hemodynamic changes, respiratory and alert status of patients for 2 hours in PACU. Patients' pain was measured using VAS (0: painless, 10: maximum pain) at intervals of 30 minutes. Independent t-test and Mann-Whitney test were used for data analysis. Findings showed that there was a significant difference between time to tremor and time to cooperation variables in the two groups. Mean comparison showed that the mean time to tremor and time to cooperation in the Propofol group was higher than the Dexmedetomidine (DEX) group. Other findings showed that there was no significant difference between BIS in the two groups. The results also showed that there was a significant difference between VAS and surgeon satisfaction variables in the two groups. Mean VAS in Propofol group was significantly higher than DEX group. Mean of surgeon satisfaction in the DEX group was significantly higher than Propofol group. In general, it can be said that patients with Parkinson's disease, Dexmedetomidine is superior drug to Propofol to deep brain stimulation.

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Deep brain stimulation for Parkinson's disease: Surgical issues

et al. 2006

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Numerous factors need to be taken into account when implanting deep brain stimulation (DBS) systems into patients with Parkinson's disease. The surgical procedure itself can be divided into immediate preoperative, intraoperative, and immediate postoperative phases. Preoperative considerations include medication withdrawal issues, stereotactic equipment choices, imaging modalities, and targeting strategy. Intraoperative considerations focus on methods for physiological confirmation of a given target for DBS electrode deployment. Terms such as microelectrode recording, microstimulation, and macrostimulation will be defined to clarify inconsistencies in the literature. Advantages and disadvantages of each technique will be addressed. Furthermore, operative decisions such as staging, choice of electrode and implantable pulse generator, and methods of device fixation will be outlined. Postoperative issues include imaging considerations, including magnetic resonance safety, device-device interactions, and immediate surgical complications pertaining to the DBS procedure. This report outlines answers to a series of questions developed to address all aspects of the DBS surgical procedure and decision-making with a systematic overview of the literature (until mid-2004) and by the expert opinion of the authors. This is a report from the Consensus on Deep Brain Stimulation for Parkinson's Disease, a project commissioned by the Congress of Neurological Surgeons and the Movement Disorder Society. It outlines answers to a series of questions developed to address all surgical aspects of deep brain stimulation.

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Subthalamic Stimulation in Parkinson Disease

Abstract: Although the improvement of parkinsonian motor disability is greater in PD patients who receive local anesthesia during surgery, general anesthesia can be performed in patients unable to tolerate prolonged states without levodopa.

Cited by 109 publications

References 11 publications

Controversial Issues in Deep Brain Stimulation in Parkinson's Disease

Controversial Issues in Deep Brain Stimulation in Parkinson's Disease

Comparison of the Effect of Dexmedetomidine and Propofol on Duration of Starting Tremor after Drug discontinuation in Parkinson's Patients under Deep Brain stimulation

Deep brain stimulation for Parkinson's disease: Surgical issues

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