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Tytuł:
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Sevoflurane and Parkinson's Disease: Subthalamic Nucleus Neuronal Activity and Clinical Outcome of Deep Brain Stimulation.
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Autorzy:
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Tsai ST; From the Department of Neurosurgery (S.-T.T., S.-Y.C.) Department of Anesthesiology (T.-Y.C.), Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation/Tzu Chi University, Hualien, Taiwan the Institute of Medical Sciences (S.-T.T., S.-Y.C.) the Department of Anatomy (G.-F.T.) Department of Physiology and Master Program in Medical Physiology (C.-C.K.), School of Medicine, Tzu Chi University, Hualien, Taiwan.
Tseng GF
Kuo CC
Chen TY
Chen SY
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Źródło:
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Anesthesiology [Anesthesiology] 2020 May; Vol. 132 (5), pp. 1034-1044.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: Philadelphia Pa : Lippincott Williams & Wilkins
Original Publication: Philadelphia : American Society of Anesthesiologists
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MeSH Terms:
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Anesthetics, Inhalation/*administration & dosage
Deep Brain Stimulation/*methods
Neurons/*drug effects
Parkinson Disease/*therapy
Sevoflurane/*administration & dosage
Subthalamic Nucleus/*drug effects
Action Potentials/drug effects ; Action Potentials/physiology ; Adult ; Aged ; Anesthetics, Local/administration & dosage ; Beta Rhythm/drug effects ; Beta Rhythm/physiology ; Cohort Studies ; Electroencephalography/drug effects ; Electroencephalography/methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neurons/physiology ; Parkinson Disease/physiopathology ; Subthalamic Nucleus/physiology ; Treatment Outcome
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Substance Nomenclature:
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0 (Anesthetics, Inhalation)
0 (Anesthetics, Local)
38LVP0K73A (Sevoflurane)
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Entry Date(s):
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Date Created: 20200212 Date Completed: 20200714 Latest Revision: 20200714
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Update Code:
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20240105
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DOI:
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10.1097/ALN.0000000000003177
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PMID:
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32044799
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Background: General anesthetics-induced changes of electrical oscillations in the basal ganglia may render the identification of the stimulation targets difficult. The authors hypothesized that while sevoflurane anesthesia entrains coherent lower frequency oscillations, it does not affect the identification of the subthalamic nucleus and clinical outcome.
Methods: A cohort of 19 patients with Parkinson's disease with comparable disability underwent placement of electrodes under either sevoflurane general anesthesia (n = 10) or local anesthesia (n = 9). Microelectrode recordings during targeting were compared for neuronal spiking characteristics and oscillatory dynamics. Clinical outcomes were compared at 5-yr follow-up.
Results: Under sevoflurane anesthesia, subbeta frequency oscillations predominated (general vs. local anesthesia, mean ± SD; delta: 13 ± 7.3% vs. 7.8 ± 4.8%; theta: 8.4 ± 4.1% vs. 3.9 ± 1.6%; alpha: 8.1 ± 4.1% vs. 4.8 ± 1.5%; all P < 0.001). In addition, distinct dorsolateral beta and ventromedial gamma oscillations were detected in the subthalamic nucleus solely in awake surgery (mean ± SD; dorsal vs. ventral beta band power: 20.5 ± 6.6% vs. 15.4 ± 4.3%; P < 0.001). Firing properties of subthalamic neurons did not show significant difference between groups. Clinical outcomes with regard to improvement in motor and psychiatric symptoms and adverse effects were comparable for both groups. Tract numbers of microelectrode recording, active contact coordinates, and stimulation parameters were also equivalent.
Conclusions: Sevoflurane general anesthesia decreased beta-frequency oscillations by inducing coherent lower frequency oscillations, comparable to the pattern seen in the scalp electroencephalogram. Nevertheless, sevoflurane-induced changes in electrical activity patterns did not reduce electrode placement accuracy and clinical effect. These observations suggest that microelectrode-guided deep brain stimulation under sevoflurane anesthesia is a feasible clinical option.
