General, local anesthesia for Parkinson’s surgery yield similar adverse effects

There was no difference between asleep and awake deep brain stimulation surgery in patients with Parkinson’s disease with regard to cognitive, mood and behavioral adverse effects, according to a study published in JAMA Neurology.

“With this study we have demonstrated that deep brain stimulation surgery in Parkinson’s disease can be performed under general anesthesia, without loss of effectiveness of the treatment when compared to the conventional procedure in which electrode placement was performed in the awake patient with intraoperative clinical testing for target verification,” P. Rick Schuurman, MD, PhD, department of neurosurgery, Amsterdam University Medical Centers, the Netherlands, told Healio Neurology. “Surgery under general anesthesia greatly reduces the burden of the procedure for the patient and also makes the procedure faster.”

Schuurman and colleagues randomly assigned patients with Parkinson’s disease who underwent subthalamic nucleus deep brain stimulation surgery either while awake (local anesthesia n = 56) or asleep (general anesthesia n = 54). The between-group difference in cognitive, mood and behavioral adverse effects measured by a composite score served as the primary outcome. Other outcomes included Movement Disorders Society Unified Parkinson’s Disease Rating Scale, the patient assessment of surgical burden and operative time. Investigators calculated Levodopa Equivalent Daily Dose to assess the effect on Parkinson’s disease medication.

The investigators reported that 103 patients completed the 6-month follow-up.

Results showed adverse cognitive, mood and behavioral effects post-deep brain stimulation surgery in 15 of 52 patients in the awake group compared with 11 of 51 in asleep group (OR = 0.7; 95% CI, 0.3-1.7). Groups did not differ regarding improvement in off-medication Movement Disorders Society Unified Parkinson’s Disease Rating Scale Motor Examination scores (awake group mean [SD], –27.3 [17.5] points; asleep group mean [SD], –25.3 [14.3] points; mean difference, –2. 95%CI, –8.1 to 4.2).

Patients who underwent asleep surgery reported it was less burdensome compared with awake surgery. In addition, asleep surgery was 26 minutes shorter than awake surgery.