Deep Brain Stimulation (DBS), the procedure of placing stimulating electrodes into targeted brain structures, was first introduced in 1987 (Benabid et al. 1991; Benabid et al. 1987). There are several theories explaining the efficacy of DBS, (Chakrabarti et al. 2014; Frost et al. 2009; Halpern et al. 2007; Pereira et al. 2007), but ample evidence exists on the safety and efficacy of DBS in Parkinson’s Disease (PD), leading to expanded indications for DBS including benign tremors, dystonia, epilepsy and other neuropsychiatric disorders (Benabid et al. 2009; Marangell et al. 2007). Prior to the introduction of DBS, surgical treatment for PD traditionally involved permanent removal of parts of the brain – thalamotomy, pallidotomy, and cingulotomy
…show more content…
2015, Raz et al. 2010). MERs help guide the placement of electrodes, so their accuracy is critical for the success of procedures and interference may occur with intravenous anesthetics, such as propofol (Raz et al. 2010). In addition to MERs, macrostimulation testing is very important. Since the goal of DBS is to treat the symptoms of Parkinson’s, it is helpful to see intraoperatively if stimulation of the targeted brain region alters the characteristic tremors, rigidity, and bradykinesia of PD. Some medications can interfere with these symptoms, thus interfering with macrostimulation testing. For example, remifentanil is known to cause rigidity (Hogue et al. 1996). In a recent retrospective study, Lange et al. found that length of surgery was significantly increased (ps. The authors noted that placing the pulse generator and drilling the burr holes under general anesthesia reduced patient anxiety due to lack of awareness of the drilling process. The second stage in this reversed model includes microelectrode recording and macrostimulation testing under local anesthesia (Van Horne et al. 2015). Further investigation of this technique could show promise in the future of DBS staging and anesthetic
2015, Raz et al. 2010). MERs help guide the placement of electrodes, so their accuracy is critical for the success of procedures and interference may occur with intravenous anesthetics, such as propofol (Raz et al. 2010). In addition to MERs, macrostimulation testing is very important. Since the goal of DBS is to treat the symptoms of Parkinson’s, it is helpful to see intraoperatively if stimulation of the targeted brain region alters the characteristic tremors, rigidity, and bradykinesia of PD. Some medications can interfere with these symptoms, thus interfering with macrostimulation testing. For example, remifentanil is known to cause rigidity (Hogue et al. 1996). In a recent retrospective study, Lange et al. found that length of surgery was significantly increased (ps. The authors noted that placing the pulse generator and drilling the burr holes under general anesthesia reduced patient anxiety due to lack of awareness of the drilling process. The second stage in this reversed model includes microelectrode recording and macrostimulation testing under local anesthesia (Van Horne et al. 2015). Further investigation of this technique could show promise in the future of DBS staging and anesthetic