Comparison of Awake vs. Asleep Surgery for Subthalamic Deep Brain Stimulation in Parkinson's Disease
Background Deep brain stimulation (DBS) surgery for Parkinson's disease (PD) is usually performed as awake surgery allowing sufficient intraoperative testing. Recently, outcomes after asleep surgery have been assumed comparable. However, direct comparisons between awake and asleep surgery are s...
Gespeichert in:
| Veröffentlicht in: | Neuromodulation (Malden, Mass.) Mass.), 2018-08, Vol.21 (6), p.541-547 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 547 |
|---|---|
| container_issue | 6 |
| container_start_page | 541 |
| container_title | Neuromodulation (Malden, Mass.) |
| container_volume | 21 |
| creator | Blasberg, Fabian Wojtecki, Lars Elben, Saskia Slotty, Philipp Jörg Vesper, Jan Schnitzler, Alfons Groiss, Stefan Jun |
| description | Background
Deep brain stimulation (DBS) surgery for Parkinson's disease (PD) is usually performed as awake surgery allowing sufficient intraoperative testing. Recently, outcomes after asleep surgery have been assumed comparable. However, direct comparisons between awake and asleep surgery are scarce.
Objective
To investigate the difference between awake and asleep surgery comparing motor and nonmotor outcome after subthalamic nucleus (STN)‐DBS in a large single center PD population.
Methods
Ninety‐six patients were retrospectively matched pairwise (48 asleep and 48 awake) and compared regarding improvement of Unified PD Rating Scale Motor Score (UPDRS‐III), cognitive function, Levodopa‐equivalent‐daily‐dose (LEDD), stimulation amplitudes, side effects, surgery duration, and complication rates. Routine testing took place at three months and one year postoperatively.
Results
Chronic DBS effects (UPDRS‐III without medication and with stimulation on [OFF/ON]) significantly improved UPDRS‐III only after awake surgery at three months and in both groups one year postoperatively. Acute effects (percentage UPDRS‐III reduction after activation of stimulation) were also significantly better after awake surgery at three months but not at one year compared to asleep surgery. UPDRS‐III subitems “freezing” and “speech” were significantly worse after asleep surgery at three months and one year, respectively. LEDD was significantly lower after awake surgery only one week postoperatively. The other measures did not differ between groups.
Conclusions
Overall motor function improved faster in the awake surgery group, but the difference ceased after one year. However, axial subitems were worse in the asleep surgery group suggesting that worsening of axial symptoms was risked improving overall motor function. Awake surgery still seems advantageous for STN‐DBS in PD, although asleep surgery may be considered with lower threshold in patients not suitable for awake surgery. |
| doi_str_mv | 10.1111/ner.12766 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2013514958</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2013514958</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3536-7ad78364eacb80f71ba14dc0d8735a02c8dcd64ab63f2e513850092d283bb5a53</originalsourceid><addsrcrecordid>eNp1kE1PwkAQhjdGI4ge_ANmEw_qobAf3XZ7RMCPhKgRPTfTdqsL_cBdKuHfu1j0YOJcZibz5MnkReiUkj51NaiU6VMWBsEe6lLBhEd9wvfdTCLfC6mIOujI2jkhNIxYeIg6LBKciYB0UTaqyyUYbesK1zkermGh8Kft46EtlFriWWPelNngvDZuTlbvUECpUzzeHq8N6ArPVrpsClhpp3DrE5iFrpzvwuKxtgqsOkYHORRWnex6D73eTF5Gd9708fZ-NJx6KRc88ELIQskDX0GaSJKHNAHqZynJZMgFEJbKLM0CH5KA50wJyqUgJGIZkzxJBAjeQ5etd2nqj0bZVVxqm6qigErVjY0ZoVxQPxLSoed_0HndmMp956jIF0QK6TvqqqVSU1trVB4vjS7BbGJK4m30sYs-_o7esWc7Y5OUKvslf7J2wKAF1rpQm_9N8cPkuVV-ASAyjFs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2094508584</pqid></control><display><type>article</type><title>Comparison of Awake vs. Asleep Surgery for Subthalamic Deep Brain Stimulation in Parkinson's Disease</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Blasberg, Fabian ; Wojtecki, Lars ; Elben, Saskia ; Slotty, Philipp Jörg ; Vesper, Jan ; Schnitzler, Alfons ; Groiss, Stefan Jun</creator><creatorcontrib>Blasberg, Fabian ; Wojtecki, Lars ; Elben, Saskia ; Slotty, Philipp Jörg ; Vesper, Jan ; Schnitzler, Alfons ; Groiss, Stefan Jun</creatorcontrib><description>Background
Deep brain stimulation (DBS) surgery for Parkinson's disease (PD) is usually performed as awake surgery allowing sufficient intraoperative testing. Recently, outcomes after asleep surgery have been assumed comparable. However, direct comparisons between awake and asleep surgery are scarce.
Objective
To investigate the difference between awake and asleep surgery comparing motor and nonmotor outcome after subthalamic nucleus (STN)‐DBS in a large single center PD population.
Methods
Ninety‐six patients were retrospectively matched pairwise (48 asleep and 48 awake) and compared regarding improvement of Unified PD Rating Scale Motor Score (UPDRS‐III), cognitive function, Levodopa‐equivalent‐daily‐dose (LEDD), stimulation amplitudes, side effects, surgery duration, and complication rates. Routine testing took place at three months and one year postoperatively.
Results
Chronic DBS effects (UPDRS‐III without medication and with stimulation on [OFF/ON]) significantly improved UPDRS‐III only after awake surgery at three months and in both groups one year postoperatively. Acute effects (percentage UPDRS‐III reduction after activation of stimulation) were also significantly better after awake surgery at three months but not at one year compared to asleep surgery. UPDRS‐III subitems “freezing” and “speech” were significantly worse after asleep surgery at three months and one year, respectively. LEDD was significantly lower after awake surgery only one week postoperatively. The other measures did not differ between groups.
Conclusions
Overall motor function improved faster in the awake surgery group, but the difference ceased after one year. However, axial subitems were worse in the asleep surgery group suggesting that worsening of axial symptoms was risked improving overall motor function. Awake surgery still seems advantageous for STN‐DBS in PD, although asleep surgery may be considered with lower threshold in patients not suitable for awake surgery.</description><identifier>ISSN: 1094-7159</identifier><identifier>EISSN: 1525-1403</identifier><identifier>DOI: 10.1111/ner.12766</identifier><identifier>PMID: 29532560</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Acute effects ; Aged ; Anesthesia ; Antiparkinson Agents - therapeutic use ; Cognition - physiology ; Cognitive ability ; Deep brain stimulation ; Deep Brain Stimulation - adverse effects ; Deep Brain Stimulation - methods ; Electrical stimuli ; Female ; Freezing ; Humans ; Levodopa ; Levodopa - therapeutic use ; Male ; Middle Aged ; Movement disorders ; Neurodegenerative diseases ; Parkinson Disease - physiopathology ; Parkinson Disease - therapy ; Parkinson's disease ; Retrospective Studies ; Severity of Illness Index ; Solitary tract nucleus ; Statistics, Nonparametric ; Subthalamic nucleus ; Subthalamic Nucleus - physiology ; Surgery ; Treatment Outcome ; Unified Parkinson's Disease Rating Scale ; Wakefulness - physiology</subject><ispartof>Neuromodulation (Malden, Mass.), 2018-08, Vol.21 (6), p.541-547</ispartof><rights>2018 International Neuromodulation Society</rights><rights>2018 International Neuromodulation Society.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3536-7ad78364eacb80f71ba14dc0d8735a02c8dcd64ab63f2e513850092d283bb5a53</citedby><cites>FETCH-LOGICAL-c3536-7ad78364eacb80f71ba14dc0d8735a02c8dcd64ab63f2e513850092d283bb5a53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29532560$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Blasberg, Fabian</creatorcontrib><creatorcontrib>Wojtecki, Lars</creatorcontrib><creatorcontrib>Elben, Saskia</creatorcontrib><creatorcontrib>Slotty, Philipp Jörg</creatorcontrib><creatorcontrib>Vesper, Jan</creatorcontrib><creatorcontrib>Schnitzler, Alfons</creatorcontrib><creatorcontrib>Groiss, Stefan Jun</creatorcontrib><title>Comparison of Awake vs. Asleep Surgery for Subthalamic Deep Brain Stimulation in Parkinson's Disease</title><title>Neuromodulation (Malden, Mass.)</title><addtitle>Neuromodulation</addtitle><description>Background
Deep brain stimulation (DBS) surgery for Parkinson's disease (PD) is usually performed as awake surgery allowing sufficient intraoperative testing. Recently, outcomes after asleep surgery have been assumed comparable. However, direct comparisons between awake and asleep surgery are scarce.
Objective
To investigate the difference between awake and asleep surgery comparing motor and nonmotor outcome after subthalamic nucleus (STN)‐DBS in a large single center PD population.
Methods
Ninety‐six patients were retrospectively matched pairwise (48 asleep and 48 awake) and compared regarding improvement of Unified PD Rating Scale Motor Score (UPDRS‐III), cognitive function, Levodopa‐equivalent‐daily‐dose (LEDD), stimulation amplitudes, side effects, surgery duration, and complication rates. Routine testing took place at three months and one year postoperatively.
Results
Chronic DBS effects (UPDRS‐III without medication and with stimulation on [OFF/ON]) significantly improved UPDRS‐III only after awake surgery at three months and in both groups one year postoperatively. Acute effects (percentage UPDRS‐III reduction after activation of stimulation) were also significantly better after awake surgery at three months but not at one year compared to asleep surgery. UPDRS‐III subitems “freezing” and “speech” were significantly worse after asleep surgery at three months and one year, respectively. LEDD was significantly lower after awake surgery only one week postoperatively. The other measures did not differ between groups.
Conclusions
Overall motor function improved faster in the awake surgery group, but the difference ceased after one year. However, axial subitems were worse in the asleep surgery group suggesting that worsening of axial symptoms was risked improving overall motor function. Awake surgery still seems advantageous for STN‐DBS in PD, although asleep surgery may be considered with lower threshold in patients not suitable for awake surgery.</description><subject>Acute effects</subject><subject>Aged</subject><subject>Anesthesia</subject><subject>Antiparkinson Agents - therapeutic use</subject><subject>Cognition - physiology</subject><subject>Cognitive ability</subject><subject>Deep brain stimulation</subject><subject>Deep Brain Stimulation - adverse effects</subject><subject>Deep Brain Stimulation - methods</subject><subject>Electrical stimuli</subject><subject>Female</subject><subject>Freezing</subject><subject>Humans</subject><subject>Levodopa</subject><subject>Levodopa - therapeutic use</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Movement disorders</subject><subject>Neurodegenerative diseases</subject><subject>Parkinson Disease - physiopathology</subject><subject>Parkinson Disease - therapy</subject><subject>Parkinson's disease</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><subject>Solitary tract nucleus</subject><subject>Statistics, Nonparametric</subject><subject>Subthalamic nucleus</subject><subject>Subthalamic Nucleus - physiology</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Unified Parkinson's Disease Rating Scale</subject><subject>Wakefulness - physiology</subject><issn>1094-7159</issn><issn>1525-1403</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1PwkAQhjdGI4ge_ANmEw_qobAf3XZ7RMCPhKgRPTfTdqsL_cBdKuHfu1j0YOJcZibz5MnkReiUkj51NaiU6VMWBsEe6lLBhEd9wvfdTCLfC6mIOujI2jkhNIxYeIg6LBKciYB0UTaqyyUYbesK1zkermGh8Kft46EtlFriWWPelNngvDZuTlbvUECpUzzeHq8N6ArPVrpsClhpp3DrE5iFrpzvwuKxtgqsOkYHORRWnex6D73eTF5Gd9708fZ-NJx6KRc88ELIQskDX0GaSJKHNAHqZynJZMgFEJbKLM0CH5KA50wJyqUgJGIZkzxJBAjeQ5etd2nqj0bZVVxqm6qigErVjY0ZoVxQPxLSoed_0HndmMp956jIF0QK6TvqqqVSU1trVB4vjS7BbGJK4m30sYs-_o7esWc7Y5OUKvslf7J2wKAF1rpQm_9N8cPkuVV-ASAyjFs</recordid><startdate>201808</startdate><enddate>201808</enddate><creator>Blasberg, Fabian</creator><creator>Wojtecki, Lars</creator><creator>Elben, Saskia</creator><creator>Slotty, Philipp Jörg</creator><creator>Vesper, Jan</creator><creator>Schnitzler, Alfons</creator><creator>Groiss, Stefan Jun</creator><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201808</creationdate><title>Comparison of Awake vs. Asleep Surgery for Subthalamic Deep Brain Stimulation in Parkinson's Disease</title><author>Blasberg, Fabian ; Wojtecki, Lars ; Elben, Saskia ; Slotty, Philipp Jörg ; Vesper, Jan ; Schnitzler, Alfons ; Groiss, Stefan Jun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3536-7ad78364eacb80f71ba14dc0d8735a02c8dcd64ab63f2e513850092d283bb5a53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Acute effects</topic><topic>Aged</topic><topic>Anesthesia</topic><topic>Antiparkinson Agents - therapeutic use</topic><topic>Cognition - physiology</topic><topic>Cognitive ability</topic><topic>Deep brain stimulation</topic><topic>Deep Brain Stimulation - adverse effects</topic><topic>Deep Brain Stimulation - methods</topic><topic>Electrical stimuli</topic><topic>Female</topic><topic>Freezing</topic><topic>Humans</topic><topic>Levodopa</topic><topic>Levodopa - therapeutic use</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Movement disorders</topic><topic>Neurodegenerative diseases</topic><topic>Parkinson Disease - physiopathology</topic><topic>Parkinson Disease - therapy</topic><topic>Parkinson's disease</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><topic>Solitary tract nucleus</topic><topic>Statistics, Nonparametric</topic><topic>Subthalamic nucleus</topic><topic>Subthalamic Nucleus - physiology</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Unified Parkinson's Disease Rating Scale</topic><topic>Wakefulness - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Blasberg, Fabian</creatorcontrib><creatorcontrib>Wojtecki, Lars</creatorcontrib><creatorcontrib>Elben, Saskia</creatorcontrib><creatorcontrib>Slotty, Philipp Jörg</creatorcontrib><creatorcontrib>Vesper, Jan</creatorcontrib><creatorcontrib>Schnitzler, Alfons</creatorcontrib><creatorcontrib>Groiss, Stefan Jun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Neuromodulation (Malden, Mass.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Blasberg, Fabian</au><au>Wojtecki, Lars</au><au>Elben, Saskia</au><au>Slotty, Philipp Jörg</au><au>Vesper, Jan</au><au>Schnitzler, Alfons</au><au>Groiss, Stefan Jun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of Awake vs. Asleep Surgery for Subthalamic Deep Brain Stimulation in Parkinson's Disease</atitle><jtitle>Neuromodulation (Malden, Mass.)</jtitle><addtitle>Neuromodulation</addtitle><date>2018-08</date><risdate>2018</risdate><volume>21</volume><issue>6</issue><spage>541</spage><epage>547</epage><pages>541-547</pages><issn>1094-7159</issn><eissn>1525-1403</eissn><abstract>Background
Deep brain stimulation (DBS) surgery for Parkinson's disease (PD) is usually performed as awake surgery allowing sufficient intraoperative testing. Recently, outcomes after asleep surgery have been assumed comparable. However, direct comparisons between awake and asleep surgery are scarce.
Objective
To investigate the difference between awake and asleep surgery comparing motor and nonmotor outcome after subthalamic nucleus (STN)‐DBS in a large single center PD population.
Methods
Ninety‐six patients were retrospectively matched pairwise (48 asleep and 48 awake) and compared regarding improvement of Unified PD Rating Scale Motor Score (UPDRS‐III), cognitive function, Levodopa‐equivalent‐daily‐dose (LEDD), stimulation amplitudes, side effects, surgery duration, and complication rates. Routine testing took place at three months and one year postoperatively.
Results
Chronic DBS effects (UPDRS‐III without medication and with stimulation on [OFF/ON]) significantly improved UPDRS‐III only after awake surgery at three months and in both groups one year postoperatively. Acute effects (percentage UPDRS‐III reduction after activation of stimulation) were also significantly better after awake surgery at three months but not at one year compared to asleep surgery. UPDRS‐III subitems “freezing” and “speech” were significantly worse after asleep surgery at three months and one year, respectively. LEDD was significantly lower after awake surgery only one week postoperatively. The other measures did not differ between groups.
Conclusions
Overall motor function improved faster in the awake surgery group, but the difference ceased after one year. However, axial subitems were worse in the asleep surgery group suggesting that worsening of axial symptoms was risked improving overall motor function. Awake surgery still seems advantageous for STN‐DBS in PD, although asleep surgery may be considered with lower threshold in patients not suitable for awake surgery.</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>29532560</pmid><doi>10.1111/ner.12766</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1094-7159 |
| ispartof | Neuromodulation (Malden, Mass.), 2018-08, Vol.21 (6), p.541-547 |
| issn | 1094-7159 1525-1403 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2013514958 |
| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Acute effects Aged Anesthesia Antiparkinson Agents - therapeutic use Cognition - physiology Cognitive ability Deep brain stimulation Deep Brain Stimulation - adverse effects Deep Brain Stimulation - methods Electrical stimuli Female Freezing Humans Levodopa Levodopa - therapeutic use Male Middle Aged Movement disorders Neurodegenerative diseases Parkinson Disease - physiopathology Parkinson Disease - therapy Parkinson's disease Retrospective Studies Severity of Illness Index Solitary tract nucleus Statistics, Nonparametric Subthalamic nucleus Subthalamic Nucleus - physiology Surgery Treatment Outcome Unified Parkinson's Disease Rating Scale Wakefulness - physiology |
| title | Comparison of Awake vs. Asleep Surgery for Subthalamic Deep Brain Stimulation in Parkinson's Disease |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-30T11%3A42%3A35IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Comparison%20of%20Awake%20vs.%20Asleep%20Surgery%20for%20Subthalamic%20Deep%20Brain%20Stimulation%20in%20Parkinson's%20Disease&rft.jtitle=Neuromodulation%20(Malden,%20Mass.)&rft.au=Blasberg,%20Fabian&rft.date=2018-08&rft.volume=21&rft.issue=6&rft.spage=541&rft.epage=547&rft.pages=541-547&rft.issn=1094-7159&rft.eissn=1525-1403&rft_id=info:doi/10.1111/ner.12766&rft_dat=%3Cproquest_cross%3E2013514958%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2094508584&rft_id=info:pmid/29532560&rfr_iscdi=true |