The effect of dopaminergic therapy on intraoperative microelectrode recordings for subthalamic deep brain stimulation under GA: can we operate on patients 'on medications'?
Identifieur interne : 001373 ( PubMed/Curation ); précédent : 001372; suivant : 001374The effect of dopaminergic therapy on intraoperative microelectrode recordings for subthalamic deep brain stimulation under GA: can we operate on patients 'on medications'?
Auteurs : Mohammed J. Asha [Royaume-Uni] ; Jamilla Kausar [Royaume-Uni] ; Hari Krovvidi [Royaume-Uni] ; Colin Shirley [Royaume-Uni] ; Anwen White [Royaume-Uni] ; Ramesh Chelvarajah [Royaume-Uni] ; James A. Hodson [Royaume-Uni] ; Hardev Pall [Royaume-Uni] ; Rosalind D. Mitchell [Royaume-Uni]Source :
- Acta neurochirurgica [ 0942-0940 ] ; 2016.
Descripteurs français
- KwdFr :
- MESH :
- pharmacologie : Antiparkinsoniens, Lévodopa.
- Adulte d'âge moyen, Anesthésie générale, Femelle, Humains, Mâle, Noyau subthalamique, Stimulation cérébrale profonde, Sujet âgé.
English descriptors
- KwdEn :
- MESH :
- chemical , pharmacology : Antiparkinson Agents, Levodopa.
- drug effects : Subthalamic Nucleus.
- Aged, Anesthesia, General, Contraindications, Deep Brain Stimulation, Female, Humans, Male, Middle Aged.
Abstract
Microelectrode recording (MER) plays an important role in target refinement in deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD). Traditionally, patients were operated on in the 'off-medication' state to allow intraoperative assessment of the patient response to direct STN stimulation. The development of intraoperative microelectrode recording (MER) has facilitated the introduction of general anaesthesia (GA). However, the routine withdrawal of dopaminergic medications has remained as standard practice. This retrospective review examines the effect of continuing these medications on intraoperative MER for subthalamic DBS insertion under GA and discusses the clinical implication of this approach.
DOI: 10.1007/s00701-015-2631-1
PubMed: 26602236
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Asha</name><affiliation wicri:level="1"><nlm:affiliation>Divisions of Neurosurgery, University Hospital Birmingham, Birmingham, UK. mohammedjamil80@yahoo.com.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Divisions of Neurosurgery, University Hospital Birmingham, Birmingham</wicri:regionArea></affiliation></author><author><name sortKey="Kausar, Jamilla" sort="Kausar, Jamilla" uniqKey="Kausar J" first="Jamilla" last="Kausar">Jamilla Kausar</name><affiliation wicri:level="1"><nlm:affiliation>Divisions of Neurosurgery, University Hospital Birmingham, Birmingham, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Divisions of Neurosurgery, University Hospital Birmingham, Birmingham</wicri:regionArea></affiliation></author><author><name sortKey="Krovvidi, Hari" sort="Krovvidi, Hari" uniqKey="Krovvidi H" first="Hari" last="Krovvidi">Hari Krovvidi</name><affiliation wicri:level="1"><nlm:affiliation>Divisions of Neuroanaesthesia, University Hospital Birmingham, Birmingham, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Divisions of Neuroanaesthesia, University Hospital Birmingham, Birmingham</wicri:regionArea></affiliation></author><author><name sortKey="Shirley, Colin" sort="Shirley, Colin" uniqKey="Shirley C" first="Colin" last="Shirley">Colin Shirley</name><affiliation wicri:level="1"><nlm:affiliation>Divisions of Neurophysiology, University Hospital Birmingham, Birmingham, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Divisions of Neurophysiology, University Hospital Birmingham, Birmingham</wicri:regionArea></affiliation></author><author><name sortKey="White, Anwen" sort="White, Anwen" uniqKey="White A" first="Anwen" last="White">Anwen White</name><affiliation wicri:level="1"><nlm:affiliation>Divisions of Neurosurgery, University Hospital Birmingham, Birmingham, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Divisions of Neurosurgery, University Hospital Birmingham, Birmingham</wicri:regionArea></affiliation></author><author><name sortKey="Chelvarajah, Ramesh" sort="Chelvarajah, Ramesh" uniqKey="Chelvarajah R" first="Ramesh" last="Chelvarajah">Ramesh Chelvarajah</name><affiliation wicri:level="1"><nlm:affiliation>Divisions of Neurosurgery, University Hospital Birmingham, Birmingham, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Divisions of Neurosurgery, University Hospital Birmingham, Birmingham</wicri:regionArea></affiliation></author><author><name sortKey="Hodson, James A" sort="Hodson, James A" uniqKey="Hodson J" first="James A" last="Hodson">James A. Hodson</name><affiliation wicri:level="1"><nlm:affiliation>Department of Statistics, Wolfson Computer Laboratory, Queen Elizabeth Hospital, Birmingham, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Statistics, Wolfson Computer Laboratory, Queen Elizabeth Hospital, Birmingham</wicri:regionArea></affiliation></author><author><name sortKey="Pall, Hardev" sort="Pall, Hardev" uniqKey="Pall H" first="Hardev" last="Pall">Hardev Pall</name><affiliation wicri:level="1"><nlm:affiliation>Department of Neurology, School of Clinical and Experimental Medicine, College of Medicine, University of Birmingham, Birmingham, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Neurology, School of Clinical and Experimental Medicine, College of Medicine, University of Birmingham, Birmingham</wicri:regionArea></affiliation></author><author><name sortKey="Mitchell, Rosalind D" sort="Mitchell, Rosalind D" uniqKey="Mitchell R" first="Rosalind D" last="Mitchell">Rosalind D. Mitchell</name><affiliation wicri:level="1"><nlm:affiliation>Divisions of Neurosurgery, University Hospital Birmingham, Birmingham, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Divisions of Neurosurgery, University Hospital Birmingham, Birmingham</wicri:regionArea></affiliation></author></analytic><series><title level="j">Acta neurochirurgica</title><idno type="eISSN">0942-0940</idno><imprint><date when="2016" type="published">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Anesthesia, General</term><term>Antiparkinson Agents (pharmacology)</term><term>Contraindications</term><term>Deep Brain Stimulation</term><term>Female</term><term>Humans</term><term>Levodopa (pharmacology)</term><term>Male</term><term>Middle Aged</term><term>Subthalamic Nucleus (drug effects)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte d'âge moyen</term><term>Anesthésie générale</term><term>Antiparkinsoniens (pharmacologie)</term><term>Femelle</term><term>Humains</term><term>Lévodopa (pharmacologie)</term><term>Mâle</term><term>Noyau subthalamique ()</term><term>Stimulation cérébrale profonde</term><term>Sujet âgé</term></keywords><keywords scheme="MESH" type="chemical" qualifier="pharmacology" xml:lang="en"><term>Antiparkinson Agents</term><term>Levodopa</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>Subthalamic Nucleus</term></keywords><keywords scheme="MESH" qualifier="pharmacologie" xml:lang="fr"><term>Antiparkinsoniens</term><term>Lévodopa</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Anesthesia, General</term><term>Contraindications</term><term>Deep Brain Stimulation</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte d'âge moyen</term><term>Anesthésie générale</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Noyau subthalamique</term><term>Stimulation cérébrale profonde</term><term>Sujet âgé</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Microelectrode recording (MER) plays an important role in target refinement in deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD). Traditionally, patients were operated on in the 'off-medication' state to allow intraoperative assessment of the patient response to direct STN stimulation. The development of intraoperative microelectrode recording (MER) has facilitated the introduction of general anaesthesia (GA). However, the routine withdrawal of dopaminergic medications has remained as standard practice. This retrospective review examines the effect of continuing these medications on intraoperative MER for subthalamic DBS insertion under GA and discusses the clinical implication of this approach.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Curated" Owner="NLM"><PMID Version="1">26602236</PMID><DateCompleted><Year>2016</Year><Month>10</Month><Day>05</Day></DateCompleted><DateRevised><Year>2018</Year><Month>12</Month><Day>02</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">0942-0940</ISSN><JournalIssue CitedMedium="Internet"><Volume>158</Volume><Issue>2</Issue><PubDate><Year>2016</Year><Month>Feb</Month></PubDate></JournalIssue><Title>Acta neurochirurgica</Title><ISOAbbreviation>Acta Neurochir (Wien)</ISOAbbreviation></Journal><ArticleTitle>The effect of dopaminergic therapy on intraoperative microelectrode recordings for subthalamic deep brain stimulation under GA: can we operate on patients 'on medications'?</ArticleTitle><Pagination><MedlinePgn>387-93</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1007/s00701-015-2631-1</ELocationID><Abstract><AbstractText Label="OBJECTIVES" NlmCategory="OBJECTIVE">Microelectrode recording (MER) plays an important role in target refinement in deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD). Traditionally, patients were operated on in the 'off-medication' state to allow intraoperative assessment of the patient response to direct STN stimulation. The development of intraoperative microelectrode recording (MER) has facilitated the introduction of general anaesthesia (GA). However, the routine withdrawal of dopaminergic medications has remained as standard practice. This retrospective review examines the effect of continuing these medications on intraoperative MER for subthalamic DBS insertion under GA and discusses the clinical implication of this approach.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">Retrospective review of PD patients who had bilateral STN DBS insertion was conducted. A cohort of seven patients (14 STN microelectrodes) between 2012 and 2013, who inadvertently underwent the procedure while 'on medication', was identified. This 'on-medication' group was compared to all other patients who underwent the same procedure between 2012 and 2013 and had their medications withdrawn preoperatively, the 'off-medication' group, n = 26 (52 STN DBS). The primary endpoint was defined as the number of microelectrode tracks required to obtain adequate STN recordings. A second endpoint was the length of MERs that was finally used to guide the DBS lead insertion. The Reduction of the levo-dopa equivalent daily dose (LEDD) was also examined as a surrogate marker for clinical outcome 12 months postoperatively for both groups. For the on-medication group further analysis of the clinical outcome was done relying on the change in the motor examination at 12 months following STN DBS using the following parameters (Hoehn and Yahr scale, the number of waking hours spent in the OFF state as well as the duration of dyskinesia during the ON periods).</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">The on-medication group was statistically comparable in all baseline characteristics to the off-medication group, including age at operation 57 ± 9.9 years vs. 61.5 ± 9.2 years, p = 0.34 (mean ± SD); duration of disease (11.6 ± 5 years vs. 11.3 ± 4 years, p = 0.68); gender F:M ratio (1:6 vs. 9:17, p = 0.40). Both groups had similar PD medication regimes preoperatively expressed as levodopa equivalent daily dose (LEDD) 916 mg (558-1850) vs. 744 mg (525-3591), respectively, p = 0.77. In the on-medication group, all seven patients (14 STN electrodes) had satisfactory STN recording from a single brain track versus 15 out of 26 patients (57.7 %) in the off-medication group, p = 0.06. The length of MER was 4.5 mm (3.0-5.5) in the on-medication group compared to 3.5 mm (3.0-4.5) in the off-medication group, p = 0.16. The percentage of reduction in LEDD postoperatively for the on-medication group was comparable to that in the off-medication group, 62 % versus 58 %, respectively, p > 0.05. All patients in the on-medication group had clinically significant improvement in their PD motor symptoms as assessed by the Hoehn and Yahr scale; the number of hours (of the waking day) spent in the OFF state dropped from 6.9 (±2.3) h to 0.9 (±1.6) h; the duration of dyskinesia during the ON state dropped from 64 % (±13 %) of the ON period to only 7 % (±12 %) at 12 months following STN DBS insertion.</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">STN DBS insertion under GA can be performed without the need to withdraw dompaminergic treatment preoperatively. In this review the inadvertent continuation of medications did not affect the physiological localisation of the STN or the clinical effectiveness of the procedure. The continuation of dopamine therapy is likely to improve the perioperative experience for PD patients, avoid dopamine-withdrawal complications and improve recovery. A prospective study is needed to verify the results of this review.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Asha</LastName><ForeName>Mohammed J</ForeName><Initials>MJ</Initials><AffiliationInfo><Affiliation>Divisions of Neurosurgery, University Hospital Birmingham, Birmingham, UK. mohammedjamil80@yahoo.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kausar</LastName><ForeName>Jamilla</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Divisions of Neurosurgery, University Hospital Birmingham, Birmingham, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Krovvidi</LastName><ForeName>Hari</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Divisions of Neuroanaesthesia, University Hospital Birmingham, Birmingham, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Shirley</LastName><ForeName>Colin</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Divisions of Neurophysiology, University Hospital Birmingham, Birmingham, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>White</LastName><ForeName>Anwen</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Divisions of Neurosurgery, University Hospital Birmingham, Birmingham, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chelvarajah</LastName><ForeName>Ramesh</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Divisions of Neurosurgery, University Hospital Birmingham, Birmingham, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hodson</LastName><ForeName>James A</ForeName><Initials>JA</Initials><AffiliationInfo><Affiliation>Department of Statistics, Wolfson Computer Laboratory, Queen Elizabeth Hospital, Birmingham, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pall</LastName><ForeName>Hardev</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Department of Neurology, School of Clinical and Experimental Medicine, College of Medicine, University of Birmingham, Birmingham, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mitchell</LastName><ForeName>Rosalind D</ForeName><Initials>RD</Initials><AffiliationInfo><Affiliation>Divisions of Neurosurgery, University Hospital Birmingham, Birmingham, UK.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2015</Year><Month>11</Month><Day>25</Day></ArticleDate></Article><MedlineJournalInfo><Country>Austria</Country><MedlineTA>Acta Neurochir (Wien)</MedlineTA><NlmUniqueID>0151000</NlmUniqueID><ISSNLinking>0001-6268</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000978">Antiparkinson Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>46627O600J</RegistryNumber><NameOfSubstance UI="D007980">Levodopa</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Acta Neurochir (Wien). 2016 May;158(5):1013</RefSource><PMID Version="1">26928729</PMID></CommentsCorrections><CommentsCorrections RefType="CommentIn"><RefSource>Acta Neurochir (Wien). 2016 May;158(5):1015-6</RefSource><PMID Version="1">26940482</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000768" MajorTopicYN="Y">Anesthesia, General</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000978" MajorTopicYN="Y">Antiparkinson Agents</DescriptorName><QualifierName UI="Q000494" MajorTopicYN="N">pharmacology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000075202" MajorTopicYN="N">Contraindications</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D046690" MajorTopicYN="Y">Deep Brain Stimulation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007980" MajorTopicYN="Y">Levodopa</DescriptorName><QualifierName UI="Q000494" MajorTopicYN="N">pharmacology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D020531" MajorTopicYN="N">Subthalamic Nucleus</DescriptorName><QualifierName UI="Q000187" MajorTopicYN="Y">drug effects</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">DBS</Keyword><Keyword MajorTopicYN="N">Dopaminergic therapy</Keyword><Keyword MajorTopicYN="N">MER</Keyword><Keyword MajorTopicYN="N">STN</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2015</Year><Month>06</Month><Day>26</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2015</Year><Month>11</Month><Day>02</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2015</Year><Month>11</Month><Day>26</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2015</Year><Month>11</Month><Day>26</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate 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