Background

Several meta-analyses comparing the outcome of awake versus asleep deep brain stimulation procedures could not reveal significant differences concerning the postoperative improvement of motor symptoms. Only rarely information on the procedural details is provided for awake operations and how often somnolence and disorientation occurred, which might hamper the reliability of intraoperative clinical testing. The aim of our study was to investigate possible influencing factors on the occurrence of somnolence and disorientation in awake DBS procedures.

Methods

We retrospectively analyzed 122 patients with Parkinson's disease having received implantation of a DBS system at our centre. Correlation analyses were performed for the duration of disease prior to surgery, number of microelectrode trajectories, AC-PC-coordinates of the planned target, UPDRS-scores, intraoperative application of sedative drugs, duration of the surgical procedure, perioperative application of apomorphine, and the preoperative L-DOPA equivalence dosage with the occurrence of intraoperative somnolence and disorientation.

Results

Patients with intraoperative somnolence were significantly older (p=0.039). Increased duration of the DBS procedure (p=0.020), delayed start of the surgery (p=0.049), higher number of MER trajectories (p=0.041), and the patients’ % UPDRS improvement (p=0.046) also correlated with the incidence of intraoperative somnolence. We identified the main contributing factor to intraoperative somnolence as the use of sedative drugs applied during skin incision and burr hole trepanation (p=0.019). Perioperatively applied apomorphine could reduce the occurrence of somnolent phases during the operation (p=0.026).

Conclusion

Several influencing factors were found to seemingly increase the risk of intraoperative somnolence and disorientation, while the use of sedative drugs seems to be the main contributing factor. We argue that awake DBS procedures should omit the use of sedatives for best clinical outcome. When reporting on awake DBS surgery these factors should be considered and adjusted for, to permit reliable interpretation and comparison of DBS study results.

中文翻译：

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帕金森病脑深部电刺激术中检测可靠性的影响因素

背景

几项比较清醒与睡眠深部脑刺激手术结果的荟萃分析未能揭示术后运动症状改善的显着差异。很少提供有关清醒手术的程序细节以及嗜睡和定向障碍发生频率的信息，这可能会影响术中临床测试的可靠性。我们研究的目的是调查清醒 DBS 手术中出现嗜睡和定向障碍的可能影响因素。

方法

我们回顾性分析了 122 名在我们中心接受 DBS 系统植入的帕金森病患者。对术前病程、微电极轨迹数量、计划目标的 AC-PC 坐标、UPDRS 评分、术中镇静药物的应用、手术持续时间、围手术期阿朴吗啡的应用以及术前左旋多巴当量剂量与术中嗜睡和定向障碍发生情况的关系。

结果

术中嗜睡的患者年龄明显较大（p =0.039）。DBS 手术持续时间延长 ( p = 0.020)、手术开始延迟 ( p = 0.049)、MER 轨迹数量增加 ( p = 0.041) 以及患者的 UPDRS 改善百分比 ( p = 0.046) 也与术中嗜睡的发生率。我们确定了术中嗜睡的主要因素是皮肤切口和钻孔钻孔期间使用镇静药物（p = 0.019）。围手术期应用阿朴吗啡可以减少术中嗜睡期的发生（p =0.026）。

结论

研究发现，一些影响因素似乎会增加术中嗜睡和迷失方向的风险，而镇静药物的使用似乎是主要影响因素。我们认为清醒 DBS 手术应避免使用镇静剂以获得最佳临床结果。在报告清醒 DBS 手术时，应考虑并调整这些因素，以便可靠地解释和比较 DBS 研究结果。