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FROM: WE MOVE News http://www.imakenews.com/wemovenews/e_article000298844.cfm?x=b3y2wHt,b23F 7l0n September 1, 2004 Local vs General Anesthesia for DBS Electrode Placement Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for some patients with Parkinson’s disease (PD) that is responsive to the use of levodopa (the drug that is most commonly used to treat PD). DBS-STN requires an operation during which the surgeon places electrodes into the STN, usually performed with the patient awake, using only local anesthesia. Because the brain does not have pain receptors, patients cannot feel the procedure. During the operation, the surgeon can use electrophysiologic recordings to measure the patients’ motor response to stimulation of different areas in the STN; performing these recordings in patients when they receive general anesthesia is not possible. However, some patients are too anxious or are experiencing too much pain from their PD to be able to tolerate the operation with only local anesthesia, so they must receive general anesthesia. In a recent study, researchers compared the outcomes of 15 patients who underwent operations to implant electrodes for DBS-STN with general anesthesia to the same number of patients who had the same operation but received only local anesthesia. The patients were matched based on sex, age, the length of time that they had had PD, and their motor disability—the researchers evaluated this disability with the Unified Parkinson Disease Rating Scale one month before the operation. Six months after the operation, the researchers again evaluated the patients. Both groups required less levodopa and had lower motor scores with and without levodopa than before the operation, but the general-anesthesia group required more-intense stimulation. Although the study needs to be repeated in a larger group of patients, the results suggest that, for patients with PD who require general anesthesia during the procedure, targeting of the STN appears to be less precise than in those who receive only local anesthesia. Nonetheless, the operation is successful in either case, and the need for general anesthesia should not stop patients who have severe anxiety or off-period dystonia from undergoing DBS-STN. Maltete D, Navarro S, Welter ML, et al. Subthalamic stimulation in Parkinson disease: with or without anesthesia? Arch Neurol 2004;61(3):390-2. ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn