Controlled general anaesthesia for subthalamic nucleus stimulation in Parkinson's disease.
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.
['Fluchere|F|F|', 'Witjas|T|T|', 'Eusebio|A|A|', 'Bruder|N|N|', 'Giorgi|R|R|', 'Leveque|M|M|', 'Peragut|J-C|JC|', 'Azulay|J-P|JP|', 'Regis|J|J|']
D000368:Aged D000768:Anesthesia, General D046690:Deep Brain Stimulation D054810:Deep Sedation D004567:Electrodes, Implanted D005260:Female D006801:Humans D007980:Levodopa D008297:Male D008875:Middle Aged D010300:Parkinson Disease D011569:Psychiatric Status Rating Scales D020531:Subthalamic Nucleus D016896:Treatment Outcome
PARKINSON'S DISEASE ANAESTHETICS STEREOTAXIC SURGERY