Ketamine Sedation Facilitates Asleep DBS: a multicenter retrospective study

Deep brain stimulation (DBS) is commonly and safely performed for selective Parkinson's disease patients. Many centers perform DBS lead positioning exclusively under local anesthesia, to allow for brain microelectrode recordings (MER) and testing of stimulation-related therapeutic and side effects. These measures enable physiological identification of the DBS targets based on electrophysiological properties like firing rates and patterns, optimization of lead placement accuracy, and intra-operative evaluation of therapeutic window. Nevertheless, due to the challenges of awake surgery, some centers use sedation or general anesthesia, despite the distortion of discharge properties, and potential impact on clinical outcomes. Thus, there is a need for a novel anesthesia regimen that enables sedation without compromising intra-operative monitoring. This study investigates the use of low-dose ketamine for conscious sedation during lead positioning in subthalamic nucleus (STN) DBS for Parkinson's disease patients. Three anesthetic regimens were retrospectively compared in 38 surgeries across three DBS centers: 1) Interleaved propofol-ketamine (PK), 2) Interleaved propofol-awake (PA), and 3) Fully awake (AA). All anesthesia regimens achieved satisfactory MER. Automatic detection of STN borders and subdomains using a Hidden Markov Model was similar between the groups. Patients' symptoms and cooperation during stimulation testing in the ketamine group was not altered. No major adverse effects were reported in the different anesthesia protocols. These results support the use of low-dose ketamine as a novel alternative for the existing DBS anesthesia regimens, optimizing patient's experience while preserving lead placement accuracy. A prospective study should be performed to confirm these findings.

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The role of intraoperative microelectrode recording and stimulation in subthalamic lead placement for Parkinson’s disease

PLoS ONE ◽

10.1371/journal.pone.0241752 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241752

Author(s):

Vesna Malinova ◽

Anabel Pinter ◽

Cristina Dragaescu ◽

Veit Rohde ◽

Claudia Trenkwalder ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rating Scale ◽

Good Clinical Practice ◽

Awake Surgery ◽

Microelectrode Recording ◽

Test Stimulation ◽

Lead Placement ◽

Motor Outcome ◽

Stn Dbs

Objective Intraoperative microelectrode recording (MER) and test-stimulation are regarded as the gold standard for proper placement of subthalamic (STN) deep brain stimulation (DBS) electrodes in Parkinson’s disease (PD), requiring the patient to be awake during the procedure. In accordance with good clinical practice, most attending neurologists will request the clinically most efficacious trajectory for definite lead placement. However, the necessity of microelectrode-test-stimulation is disputed, as it may limit the access to DBS therapy, excluding those not willing or incapable of undergoing awake surgery. Methods We retrospectively analyzed the MERs and microelectrode-test-stimulation results with regard to the decision on definite lead placement and clinical outcome in a cohort of 67 PD-patients with STN-DBS. All patients received bilateral quadripolar ring electrodes. To ascertain overall procedural efficacy, we calculated the surgical index (SI) by comparing preoperative motor improvement induced by levodopa to that induced by stimulation 7 to 18 months after surgery, measured as the relative difference between ON and OFF-states on the Unified Parkinson’s Disease Rating Scale motor part (UPDRS-3). Additionally, a side-specific surgical index (SSSI) was calculated using the unilateral assessable items of the UPDRS-3. The SSSI where microelectrode-test-stimulation overruled MER were compared to those where the result of microelectrode-test-stimulation was congruent to MER results. Results A total of 134 electrodes were analyzed. For final lead placement, the central trajectory was chosen in 54% of patient hemispheres. The mean SI was 0.99 (± 0.24). SSSI averaged 1.04 (± 0.45). In 37 lead placements, microelectrode-test-stimulation overruled MER in the final trajectory selection, in 27 of these lead placements adverse effects during microelectrode-test-stimulation were decisive. Neither the number of test electrodes used nor the STN-signal length had an impact on the SSSI. The SSSI did not differ between lead placements with MER/microelectrode-test-stimulation congruency and those where the results of microelectrode-test-stimulation initiated lead placement in a trajectory with shorter STN signal. Conclusion Intraoperative testing is mandatory to ensure an optimal motor outcome of STN DBS in PD-patients when using quadripolar ring electrodes. However, we also demonstrated that neither the length of the STN-signal on MER nor the number of test electrodes influenced the motor outcome.

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Clinical Markers May Identify Patients at Risk for Early Parkinson’s Disease Dementia: A Prospective Study

American Journal of Alzheimer s Disease & Other Dementias® ◽

10.1177/15333175211021369 ◽

2021 ◽

Vol 36 ◽

pp. 153331752110213

Author(s):

Anamaria Jurcau ◽

Vharoon Sharma Nunkoo

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Binary Logistic Regression ◽

Binary Logistic Regression Analysis ◽

Clinical Markers ◽

Pearson Coefficient ◽

Autonomic Dysfunctions ◽

Patients At Risk ◽

A Prospective Study ◽

State Examination

Background: The study aims at identifying features predictive of early onset of dementia in Parkinson’s disease (PD). Methods: 103 non-demented PD patients were evaluated on various scales at baseline and 89 patients at 3-year follow-up. Results: By the end of the study 43.8% of patients developed dementia. The development of dementia was linked to the baseline Mini Mental State Examination score (Pearson coefficient r = .404, p = 0.013), the presence of autonomic dysfunctions (r = −.621, p < 0.001) and insomnia (r = −.526, p = 0.001). A binary logistic regression analysis showed that the development of dementia was correlated strongly with the presence of autonomic dysfunctions (95% CI 2.60 to 52.83, p < 0.001), and insomnia (95% CI 0.60 to 0.95, p = 0.017). Conclusion: Patients with signs of autonomic dysfunction and insomnia are at higher risk for developing dementia and deserve closer monitoring of cognitive symptoms.

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Pallidal stimulation as treatment for camptocormia in Parkinson’s disease

npj Parkinson s Disease ◽

10.1038/s41531-020-00151-w ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yijie Lai ◽

Yunhai Song ◽

Daoqing Su ◽

Linbin Wang ◽

Chencheng Zhang ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Case Reports ◽

Structural Connectivity ◽

Video Recordings ◽

Lead Placement ◽

Pallidal Stimulation ◽

The Impact ◽

Deep Brain

AbstractCamptocormia is a common and often debilitating postural deformity in Parkinson’s disease (PD). Few treatments are currently effective. Deep brain stimulation (DBS) of the globus pallidus internus (GPi) shows potential in treating camptocormia, but evidence remains limited to case reports. We herein investigate the effect of GPi-DBS for treating camptocormia in a retrospective PD cohort. Thirty-six consecutive PD patients who underwent GPi-DBS were reviewed. The total and upper camptocormia angles (TCC and UCC angles) derived from video recordings of patients who received GPi-DBS were used to compare camptocormia alterations. Correlation analysis was performed to identify factors associated with the postoperative improvements. DBS lead placement and the impact of stimulation were analyzed using Lead-DBS software. Eleven patients manifested pre-surgical camptocormia: seven had lower camptocormia (TCC angles ≥ 30°; TCC-camptocormia), three had upper camptocormia (UCC angles ≥ 45°; UCC-camptocormia), and one had both. Mean follow-up time was 7.3 ± 3.3 months. GPi-DBS improved TCC-camptocormia by 40.4% (angles from 39.1° ± 10.1° to 23.3° ± 8.1°, p = 0.017) and UCC-camptocormia by 22.8% (angles from 50.5° ± 2.6° to 39.0° ± 6.7°, p = 0.012). Improvement in TCC angle was positively associated with pre-surgical TCC angles, levodopa responsiveness of the TCC angle, and structural connectivity from volume of tissue activated to somatosensory cortex. Greater improvement in UCC angles was seen in patients with larger pre-surgical UCC angles. Our study demonstrates potential effectiveness of GPi-DBS for treating camptocormia in PD patients. Future controlled studies with larger numbers of patients with PD-related camptocormia should extend our findings.

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Lower urinary tract symptoms in patients with Parkinson’s disease in a prospective study: Symptoms, urodynamics and considerations

European Urology Supplements ◽

10.1016/s1569-9056(17)30467-0 ◽

2017 ◽

Vol 16 (3) ◽

pp. e706-e709

Author(s):

J. Chunsong ◽

X. Cui ◽

H. Yan ◽

Q. Wang ◽

J. Li ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Urinary Tract ◽

Prospective Study ◽

Lower Urinary Tract Symptoms ◽

Lower Urinary Tract ◽

Urinary Tract Symptoms ◽

A Prospective Study ◽

Lower Urinary

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Randomized study of sertraline and low-dose amitriptyline in patients with Parkinson's disease and depression: Effect on quality of life

Movement Disorders ◽

10.1002/mds.20895 ◽

2006 ◽

Vol 21 (8) ◽

pp. 1119-1122 ◽

Cited By ~ 69

Author(s):

Angelo Antonini ◽

Silvana Tesei ◽

Anna Zecchinelli ◽

Paolo Barone ◽

Danilo De Gaspari ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Low Dose ◽

Randomized Study ◽

Depression Effect

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Leucopenia induced by low dose clozapine in Parkinson's disease recedes shortly after drug withdrawal. Clinical case descriptions with commentary on switch-over to olanzapine

Neurological Sciences ◽

10.1007/s100720070078 ◽

2000 ◽

Vol 21 (4) ◽

pp. 209-215 ◽

Cited By ~ 4

Author(s):

M. Onofrj ◽

A. Thomas ◽

L. Bonanni ◽

D. Iacono ◽

F. Gambi

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Clinical Case ◽

Low Dose ◽

Drug Withdrawal

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Investigation of tyrosine hydroxylase and BDNF in a low-dose rotenone model of Parkinson's disease

Journal of Chemical Neuroanatomy ◽

10.1016/j.jchemneu.2015.11.002 ◽

2015 ◽

Vol 70 ◽

pp. 33-41 ◽

Cited By ~ 19

Author(s):

Michaela E. Johnson ◽

Yoon Lim ◽

Manjula Senthilkumaran ◽

Xin-Fu Zhou ◽

Larisa Bobrovskaya

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Tyrosine Hydroxylase ◽

Low Dose

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Corrections: levodopa for parkinson’s disease (9 July, page 56)

Drug and Therapeutics Bulletin ◽

10.1136/dtb.28.21.84 ◽

1990 ◽

Vol 28 (21) ◽

pp. 84-84

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Low Dose ◽

Dose Therapy

The table incorrectly described Sinemet LS and Sinemet Plus, which are both capsules, and Madopar 125 and 62.5, which are both tablets. Reference 14 refers to the study by Lees and Stern described in the paragraph ‘Low Dose Therapy’, and should have been cited there, not later.

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