gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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

Meeting Abstract

  • presenting/speaker Jürgen Schlaier - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Daniel Deuter - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Nils Ole Schmidt - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Zacharias Kohl - Bezirksklinikum Universität Regensburg, Klinik und Poliklinik für Neurologie, Regensburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP236

doi: 10.3205/21dgnc516, urn:nbn:de:0183-21dgnc5167

Published: June 4, 2021

© 2021 Schlaier et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

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.