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Research paper
Controlled general anaesthesia for subthalamic nucleus stimulation in Parkinson's disease
  1. F Fluchere1,
  2. T Witjas1,2,
  3. A Eusebio1,2,
  4. N Bruder3,
  5. R Giorgi4,
  6. M Leveque5,
  7. J-C Peragut5,
  8. J-P Azulay1,2,
  9. J Regis5
  1. 1Department of Neurology and Movement Disorders, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France
  2. 2Institut de Neurosciences de la Timone UMR 7289 Aix Marseille Univ, CNRS, Marseille, Cedex, France
  3. 3Department of Anesthesiology, APHM, La Timone, Aix-Marseille Univ, Marseille, Cedex, France
  4. 4Service de Santé Publique et d'Information Médicale and LERTIM, APHM, La Timone, Aix-Marseille Univ, Marseille, Cedex, France
  5. 5Department of Stereotactic and Functional Neurosurgery, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France
  1. Correspondence to Dr Frederique Fluchere, Department of Neurology and Movement Disorders, APHM, La Timone, Pôle de Neurosciences cliniques, 13385 Marseille, Aix-Marseille Univ, Cedex 05, France; frederique.fluchere{at}ap-hm.fr

Abstract

Objective To report the short-term (1 year) and long-term (5 years) outcome of patients with Parkinson's disease (PD) with subthalamic nucleus (STN) stimulation operated upon under controlled general anaesthesia (GA).

Methods 213 consecutive patients with PD were included between January 2000 and March 2009 and operated upon under a particular type of GA with close control of the level of sedation allowing intraoperative recordings. 188 patients were assessed 1 year postoperatively. 65 patients also completed the long-term observation period and were evaluated 5 years postoperatively.

Results The Unified PD Rating Scale III score in the ‘Off drug—On stim’ condition was improved at 1 year and 5 years by 61% and 37%, respectively, (p<0.001). Motor complications decreased at short-term and long-term by 68% and 65%, respectively, for dyskinesia and by 52% and 48%, respectively, for fluctuations, (p<0.001). Dopaminergic treatment could also be reduced at short-term and long-term by 46% and 49%, respectively (p<0.001). There was no significant modification of mood and cognition assessments (Mattis scale and Beck depression inventory) at 1 year and 5 years. Concerning the main adverse events related to the surgery, we report four haematomas (1.9%) with two deaths (0.9%), eight cases of transient confusion (3.7%) and no epileptic seizure.

Conclusions Our results confirm that STN stimulation performed under controlled GA is efficient and has similar short-term and long-term motor effects than intervention under local anaesthesia. Furthermore, this specific procedure is not associated with more adverse events. The success of such an intervention requires strict anaesthetic monitoring and accurate STN identification.

  • PARKINSON'S DISEASE
  • STEREOTAXIC SURGERY
  • ANAESTHETICS

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