Influence of general anesthesia in intraoperative electrophysiology and postoperative efficacy of subthalamic nucleus deep brain stimulation in Parkinson's disease

Objective To analyze the influence of general anesthesia (GA) on bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in treating Parkinson's disease (PD) through microelectrode recording (MER), and discuss the differences between different modes of anesthesia. Methods A retrospective analysis was performed on clinical data of 31 PD patients accepted bilateral STN-DBS in our hospital from June 2015 to June 2017. Nine patients accepted surgery under GA (A group): 4 patients were treated with intravenous anesthesia (A1 group), and 5 patients were treated with inhalation anesthesia (A2 group); 22 patients accepted surgery under local anesthesia LA group. MER indexes, including STN discharge frequency, STN recorded length, and maximum target error, and short-term (6 months) efficacy were recorded. A linear regression analysis was performed to find possible influence factors on discharge frequency and improving rate of UPDRS scores. Results The discharge frequencies of B group, A1 group and A2 group were 51.42 Hz±6.28 Hz, 35.79 Hz±7.02 Hz and 43.18 Hz±5.87 Hz, respectively, with significant differences (F=12.181, P=0.000); as compared with that in the B group, the discharge frequencies of A1 group and A2 group were significantly lower (P 0.05). Six months after the surgery, the UPDRS-III scores and Schwab-England scores of A group and B group were decreased and daily levodopa equivalent (LEDD) was decreased. As compared with B group, A group had significantly better improvement in Hoehn & Yahr grading (P<0.05). Disease durations were positively correlated with discharge frequency (r=0.539, P=0.002); age and improving rate of UPDRS scores were negatively correlated (r=-0.572, P=0.001); preoperative LEDD and improving rate of UPDRS scores were positively correlated (r=0.725, P=0.000). Conclusions Bilateral STN-DBS performed under GA in PD enjoys good efficacy, which shows no obvious difference as compared with that under LA. Inhalation anesthesia had less influence on electrophysiology than intravenous anesthesia. Key words: Parkinson’s disease; Deep brain stimulation; Microelectrode recording; General anesthesia; Sevoflurane