Long-term effects of deep brain stimulation for Parkinson's disease under local or general anesthesia

doi:10.3969/j.issn.1672-6731.2020.12.006

Abstract

Abstract:

Objective To compare the efficacy of local anesthesia and general anesthesia of subthalamic nucleus deep brain stimulation (STN-DBS) for Parkinson's disease (PD). Methods Forty PD patients who underwent bilateral STN-DBS from January 2015 to January 2018 were retrospectively analyzed. Twenty-two patients underwent local anesthesia and 18 patients underwent general anesthesia. Pre- and post-operative Unified Parkinson's Disease Rating Scale-Ⅲ (UPDRS-Ⅲ), Hoehn-Yahr, Activities of Daily Living (ADL), Wechsler Adult Intelligence Scale (WAIS), Wechsler Memory Scale (WMS), Hamilton Depression Rating Scale (HAMD)-17 and Hamilton Anxiety Rating Scale (HAMA)-14 were used to assess the motor symptoms, daily living function, cognitive function, memory, anxiety and depression. Results The target deviation of the second electrode in general anesthesia group was lower than that in local anesthesia group[(0.98±0.39) mm vs. (1.21±0.35) mm; t=-2.041, P=0.048], the target deviation of the first electrode was not statistically significant[(0.96±0.29) mm vs. (1.01±0.35) mm; t=-0.496, P=0.623]. At 6, 12, and 24 months after surgery, the "on" and "off" UPDRS-Ⅲ scores (P=0.001, for all) and Hoehn-Yahr (P=0.001, for all) in the general anesthesia group and the local anesthesia group were all significantly decreased compared with baseline, ADL score significanly increased (P=0.001, for all). There were no significant differences in "on" and "off" UPDRS-Ⅲ, Hoehn-Yahr, ADL, WAIS and WMS scores between 2 groups (P>0.05, for all). One day after surgery, the HAMA-14 in the local anesthesia group was higher than baseline (P=0.027), in the general anesthesia group, HAMD-17 (P=0.008) and HAMA-14 (P=0.001) scores were lower than 1 d before surgery. The HAMD-17 (P=0.001, for all) and HAMA-14 (P=0.001, for all) of 2 groups at 6, 12 and 24 months after surgery were all lower than baseline, 1 d before and 1 d after surgery. HAMD-17 score in the general anesthesia group was lower than the local anesthesia group (P=0.048). Conclusions Both general anesthesia and local anesthesia STN-DBS can significantly improve PD motor symptoms and quality of life, as well as relieve the depression and anxiety symptoms, without affecting cognitive function and memory. Attention should be paid to mood fluctuations in using different anesthesia during the perioperative period. Choice of anesthesia method should be based on the patient's condition and indications.

Key words: Parkinson disease, Deep brain stimulation, Subthalamic nucleus, Anesthesia, general, Anesthesia, local, Motor disorders, Cognition disorders, Anxiety, Depression

摘要：

目的对比分析局部麻醉与全身麻醉下丘脑底核脑深部电刺激术（STN-DBS）治疗帕金森病的疗效。方法纳入2015年1月至2018年1月于局部麻醉（22例）或者全身麻醉（18例）下行双侧STN-DBS手术的原发性帕金森病患者共40例，采用统一帕金森病评价量表第三部分（UPDRS-Ⅲ）、Hoehn-Yahr分期、日常生活活动能力量表（ADL）、韦氏成人智力量表（WAIS）和韦氏记忆量表（WMS）、汉密尔顿抑郁量表（HAMD）-17和汉密尔顿焦虑量表（HAMA）-14评价手术前后运动症状、日常生活活动能力、认知功能和记忆力、抑郁和焦虑情绪。结果全身麻醉组第2根电极靶点偏移低于局部麻醉组[（0.98±0.39）mm对（1.21±0.35）mm；t=-2.041，P=0.048]，第1根电极靶点偏移组间差异无统计学意义[（0.96±0.29）mm对（1.01±0.35）mm；t=-0.496，P=0.623]。与手术前相比，术后6、12和24个月随访时全身麻醉组和局部麻醉组"开"期和"关"期UPDRS-Ⅲ评分（均P=0.001）、Hoehn-Yahr分期（均P=0.001）均明显降低，ADL评分增加（均P=0.001）；但两组各项量表评分比较差异无统计学意义（均P>0.05）。术后1 d，局部麻醉组HAMA-14评分高于入院时（P=0.027）、全身麻醉组HAMD-17评分（P=0.008）和HAMA-14评分（P=0.001）低于术前1 d；术后6、12和24个月随访时两组HAMD-17评分（均P=0.001）和HAMA-14评分（均P=0.001）分别低于入院时、术前1 d和术后1 d，且全身麻醉组HAMD-17评分低于局部麻醉组（P=0.048）。结论局部麻醉和全身麻醉下STN-DBS均可显著改善帕金森病患者的运动症状、日常生活活动能力、焦虑和抑郁情绪，且不影响认知功能和记忆力，但应注意围手术期不同麻醉方式情绪波动的相关特点，并根据患者具体情况和适应证综合选择麻醉方式。

关键词: 帕金森病, 深部脑刺激法, 丘脑底核, 麻醉, 全身, 麻醉, 局部, 运动障碍, 认知障碍, 焦虑, 抑郁

WANG Shu, ZHAO Meng, WANG Jun, WANG Xiong-fei, PAN Jun-hong, LIU Chang-qing, LIU Zhao, ZHANG Chun-sheng, ZHANG Xiao-ying, HAN Yi-xian, LUAN Guo-ming, GUAN Yu-guang. Long-term effects of deep brain stimulation for Parkinson's disease under local or general anesthesia[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(12): 1057-1065.

王澍, 赵萌, 王军, 王雄飞, 潘军红, 刘长青, 刘钊, 张春生, 张小英, 韩一仙, 栾国明, 关宇光. 不同麻醉方式下帕金森病脑深部电刺激术疗效对比分析[J]. 中国现代神经疾病杂志, 2020, 20(12): 1057-1065.

/ / Recommend / Download Citations

URL: https://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2020.12.006

https://journal11.magtechjournal.com/cjcnn/EN/Y2020/V20/I12/1057

References

[1] Ascherio A, Schwarzschild MA. The epidemiology of Parkinson's disease:risk factors and prevention[J]. Lancet Neurol, 2016, 15:1257-1272.
[2] Raza C, Anjum R, Shakeel NU. Parkinson's disease:mechanisms, translational models and management strategies[J]. Life Sci, 2019, 226:77-90.
[3] Wang YR, Zhang SS, Li J. Advances in MRI studies of Parkinson's disease with anxiety[J]. Zhongguo Xian Dai Shen Jing Ji Bing Za Zhi, 2019, 19:443-447.[王艺蓉, 张树山, 李健.帕金森病伴焦虑的磁共振成像研究进展[J]. 中国现代神经疾病杂志, 2019, 19:443-447.]
[4] Zhang Z, Chen SD. Research progress of autonomic dysfunction in Parkinson's disease[J]. Zhongguo Xian Dai Shen Jing Ji Bing Za Zhi, 2019, 19:367-373.[张哲, 陈生弟. 帕金森病自主神经功能障碍研究进展[J]. 中国现代神经疾病杂志, 2019, 19:367-373.]
[5] Schrag A, Taddei RN. Depression and anxiety in Parkinson's disease[J]. Int Rev Neurobiol, 2017, 133:623-655.
[6] Schindlbeck KA, Lucas-Jiménez O, Tang CC, Morbelli S, Arnaldi D, Pardini M, Pagani M, Ibarretxe-Bilbao N, Ojeda N, Nobili F, Eidelberg D. Metabolic network abnormalities in drug-naive Parkinson's disease[J]. Mov Disord, 2020, 35:587-594.
[7] Kim R, Kim HJ, Shin C, Park H, Kim A, Paek SH, Jeon B. Long-term effect of subthalamic nucleus deep brain stimulation on freezing of gait in Parkinson's disease[J]. J Neurosurg, 2019, 131:1797-1804.
[8] Hitti FL, Ramayya AG, McShane BJ, Yang AI, Vaughan KA, Baltuch GH. Long-term outcomes following deep brain stimulation for Parkinson's disease[J]. J Neurosurg, 2019, 18:1-6.
[9] Philipson J, Blomstedt P, Fredricks A, Hariz M, Stenmark Persson R, Jahanshahi M. Short- and long-term cognitive effects of deep brain stimulation in the caudal zona incerta versus best medical treatment in patients with Parkinson's disease[J]. J Neurosurg, 2020.[Epub ahead of print]
[10] Odekerken VJ, Boel JA, Schmand BA, de Haan RJ, Figee M, van den Munckhof P, Schuurman PR, de Bie RM; NSTAPS study group. GPi vs STN deep brain stimulation for Parkinson disease:three-year follow-up[J]. Neurology, 2016, 86:755-761.
[11] Blasberg F, Wojtecki L, Elben S, Slotty PJ, Vesper J, Schnitzler A, Groiss SJ. Comparison of awake vs. asleep surgery for subthalamicdeep brain stimulation in Parkinson's disease[J]. Neuromodulation, 2018, 21:541-547.
[12] Hagelweide K, Schö nberger AR, Kracht LW, Gründler TO, Fink GR, Schubotz RI. Motor cognition in patients treated with subthalamicnucleus deep brain stimulation:limits of compensatory overactivity in Parkinson's disease[J]. Neuropsychologia, 2018, 117:491-499.
[13] Wang J, Ponce FA, Tao J, Yu HM, Liu JY, Wang YJ, Luan GM, Ou SW. Comparison of awake and asleep deep brain stimulation for Parkinson's disease:adetailed analysis through literature review[J]. Neuromodulation, 2020, 23:444-450.
[14] Ho AL, Ali R, Connolly ID, Henderson JM, Dhall R, Stein SC, Halpern CH. Awake versus asleep deep brain stimulation for Parkinson's disease:a critical comparison and meta-analysis[J]. J Neurol Neurosurg Psychiatry, 2018, 89:687-691.
[15] Liu JY, Lü H, Tang RR, Yu HM, Ren Y, Ou SW, Pei L, Wang YJ, Wang J. Analysis of intra-operativetarget location of subthalamic nucleusin deep brain stimulation surgery for Parkinson's disease withbispectral index monitoring under general anesthesia[J]. Zhonghua Shen Jing Wai Ke Za Zhi, 2019, 35:1011-1014.[刘济源, 吕红, 汤如荣, 禹红梅, 任艳, 欧绍武, 裴凌, 王运杰, 王军. 全身麻醉脑电双频指数监测下丘脑底核脑深部电刺激术治疗帕金森病靶点定位分析[J]. 中华神经外科杂志, 2019, 35:1011-1014.]
[16] Parkinson's Disease and Movement Disorders Group of the Chinese Medical Association Neurology Branch, Parkinson's Disease and Movement Disorders Specialty of the Chinese Medical Doctor Association Neurologist Branch. Chinese Parkinson's disease diagnostic criteria (2016 edition)[J]. Zhonghua Shen Jing Ke Za Zhi, 2016, 49:268-271.[中华医学会神经病学分会帕金森病及运动障碍学组, 中国医师协会神经内科医师分会帕金森病及运动障碍专业. 中国帕金森病的诊断标准(2016版)[J]. 中华神经科杂志, 2016, 49:268-271.]
[17] Matias CM, Frizon LA, Nagel SJ, Lobel DA, Machado AG. Deep brain stimulation outcomes in patients implanted under general anesthesia with frame-based stereotaxy and intraoperative MRI[J]. J Neurosurg, 2018, 129:1572-1578.
[18] Geevarghese R, O'Gorman Tuura R, Lumsden DE, Samuel M, Ashkan K. Registration accuracy of CT/MRI fusion for localisation of deep brain stimulation electrode position:an imaging study and systematic review[J]. Stereotact Funct Neurosurg, 2016, 94:159-163.
[19] Su XL, Luo XG, Lü H, Wang J, Ren Y, He ZY. Factors predicting the instant effect of motor function after subthalamic nucleus deep brain stimulation in Parkinson's disease[J]. Transl Neurodegener, 2017, 6:14.
[20] Chen T, Mirzadeh Z, Chapple KM, Lambert M, Shill HA, Moguel-Cobos G, Tröster AI, Dhall R, Ponce FA. Clinical outcomes following awake and asleep deep brain stimulation for Parkinson disease[J]. J Neurosurg, 2018, 130:109-120.
[21] Mirzadeh Z, Chapple K, Lambert M, Evidente VG, Mahant P, Ospina MC, Samanta J, Moguel-Cobos G, Salins N, Lieberman A, Tröster AI, Dhall R, Ponce FA. Parkinson's disease outcomes after intraoperative CT-guided "asleep" deep brain stimulation in the globus pallidus internus[J]. J Neurosurg, 2016, 124:902-907.
[22] Ostrem JL, Ziman N, Galifianakis NB, Starr PA, Luciano MS, Katz M, Racine CA, Martin AJ, Markun LC, Larson PS. Clinical outcomes using clearpoint interventional MRI for deep brain stimulation lead placement in Parkinson's disease[J]. J Neurosurg, 2016, 124:908-916.
[23] Kogan M, McGuire M, Riley J. Deep brain stimulation for Parkinson disease[J]. Neurosurg Clin N Am, 2019, 30:137-146.
[24] Limousin P, Foltynie T. Long-term outcomes of deep brain stimulation in Parkinson disease[J]. Nat Rev Neurol, 2019, 15:234-242.
[25] Karl JA, Ouyang B, Colletta K, Verhagen Metman L. Long-term satisfaction and patient-centered outcomes of deep brain stimulation in Parkinson's disease[J]. Brain Sci, 2018, 8:60.
[26] Park KW, Jo S, Kim MS, Choi N, Jeon SR, Park HK, Kwon KY, Lee CS, Chung SJ. Cognitive profile as a predictor of the long-term outcome after deep brain stimulation in Parkinson's disease[J]. J Neurol Sci, 2020, 417:117063.
[27] Kim MS, Ryu HS, Park KW, Choi N, You S, Kim MJ, Kim YJ, Kim J, Kim K, Chung SJ. Age-dependent efficacy of subthalamic nucleus deep brain stimulation in young- and late-onset Parkinson's disease based on a 10 year follow-up[J]. J Neurol Sci, 2020, 416:117004.
[28] Hacker ML, Turchan M, Heusinkveld LE, Currie AD, Millan SH, Molinari AL, Konrad PE, Davis TL, Phibbs FT, Hedera P, Cannard KR, Wang L, Charles D. Deep brain stimulation in early-stage Parkinson disease:five-year outcomes[J]. Neurology, 2020, 95:e393-401.
[29] Evered LA, Silbert BS. Postoperative cognitive dysfunction and noncardiacsurgery[J]. Anesth Analg, 2018, 127:496-505.
[30] Combs HL, Folley BS, Berry DT, Segerstrom SC, Han DY, Anderson-Mooney AJ, Walls BD, van Horne C. Cognition and depression following deep brain stimulation of the subthalamicnucleus and globuspallidus pars internus in Parkinson's disease:a Meta-analysis[J]. Neuropsychol Rev, 2015, 25:439-454.
[31] Nir T, Jacob Y, Huang KH, Schwartz AE, Brallier JW, Ahn H, Kundu P, Tang CY, Delman BN, McCormick PJ, Sano M, Deiner S, Baxter MG, Mincer JS. Resting-state functional connectivity in early postanaesthesia recovery is characterised by globally reduced anticorrelations[J]. Br J Anaesth, 2020, 125:529-538.
[32] Fluchere F, Witjas T, Eusebio A, Bruder N, Giorgi R, Leveque M, Peragut JC, Azulay JP, Regis J. Controlled general anaesthesia for subthalamic nucleus stimulation in Parkinson's disease[J]. J Neurol Neurosurg Psychiatry, 2014, 85:1167-1173.

Please choose a citation manager

Content to export