Article
Risk factors for intraoperative somnolence and postoperative disorientation in deep brain stimulation for Parkinson’s disease
Risikofaktoren für das Auftreten einer intraoperativen Somnolenz und einer postoperativen Desorientiertheit bei der Tiefen Hirnstimulation von Parkinson-Patienten
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Published: | June 4, 2021 |
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Objective: In many centers deep brain stimulation for Parkinson´s disease is performed on awake patients to obtain reliable microelectrode recordings and to perform intraoperative clinical testing. However, some patients become somnolent after the testing or the implantation of the first electrode, some during the testing for the second electrode, thus, hindering reliable evaluation of the optimal stimulation site. In addition, intra- and postoperative disorientation may occur. The aim of our study was to investigate possible influencing factors.
Methods: We retrospectively analyzed 122 patients with Parkinson's disease having received implantation of a DBS system at our centre. Patient age ranged from 42 -75 years (mean 61,8 years). The occurrence of intraoperative somnolence and postoperative disorientation was correlated with 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 Apomorphin and the preoperative L-DOPA, equivalence dosage.
Results: Patients in whom intraoperative somnolence occurred were significantly older than patients without this effect (p=0,039). Patients with intraoperative somnolence had a longer duration of the disease prior to surgery (p=0,080) and their preoperative off-medication- UPDRS was higher (p=0,071). If the planned target was more medial (p=0,060) and more inferior (p=0,051) intraoperative somnolence occurred more often. Sedative drugs, applied to cover skin incision and burr hole trepanation, again, led to more pronounced somnolence (p=0,019). The same was true for longer durations of the surgical procedure (p=0,020). Higher numbers of microelectrode trajectories were more likely associated with postoperative disorientation. Perioperatively applied Apomorphin could reduce the occurrence of somnolent phases during the operation (p=0,026), whereas the amount of the preoperative L-DOPA-equivalent dosage did not seem to have any major effect.
Conclusion: Several influencing factors were found to seemingly increase the risk of intraoperative somnolence and postoperative disorientation. These factors should be taken into account and adjusted, if possible, to permit reliable interpretations of the intraoperative clinical and electrophysiological findings.