What Is the Main Idea?
Deep brain stimulation is a well-established surgical treatment for people with Parkinson’s Disease. Traditionally, it is carried out in a pain-free manner with the patient awake and sedated, so that electrode recordings can be made. However, this can be scary and uncomfortable for a patient. Recent technology and medicine developments mean that recordings can be made during general anesthetic, when a patient is asleep. The authors of the open-access research article “Awake versus Asleep Anesthesia in Deep Brain Stimulation Surgery for Parkinson’s Disease: A Systematic Review and Meta-Analysis”, published in the journal Stereotactic and Functional Neurosurgery, aimed to compare the two techniques to see if results were similar.
What Else Can You Learn?
You can learn about Parkinson’s disease and its symptoms. You will also find out how deep brain stimulation works.
Take-Home Message
Deep brain stimulation is a surgical technique used to treat Parkinson’s disease. Traditionally, the patient is awake, but sedated with painkillers. Newer technology means that there is now an option of carrying out the surgery with the patient asleep (general anesthesia). The results are similar, but patient comfort is improved.
What Is Parkinson’s Disease?
This disease – most commonly known as “Parkinson’s” – is the fastest-growing neurological problem in the world. Symptoms include difficulty moving and walking. For example, slow movements, muscle stiffness (rigidity), and shaking (tremor). These symptoms get gradually worse over many years. Other symptoms can include mild memory and thinking problems, sleep difficulties, pain, and mental well-being problems.
What Causes Parkinson’s?
People with Parkinson’s don’t have enough of a chemical called dopamine. Dopamine is made by nerve cells in the brain, and some of these cells stop working. Parkinson’s is likely caused by a combination of age, genetics, and environmental factors. It is not contagious (you cannot “catch” it).
Is There Medicine for Parkinson’s?
People with Parkinson’s can take medicines that either increase the amount of dopamine in the brain, act as a dopamine substitute, or block the breaking down of dopamine. However, medicines do not fully cure Parkinson’s or take away all of the symptoms.
What Is Deep Brain Stimulation?
Deep brain stimulation is an operation treatment for Parkinson’s movement problems. A device that is a bit like a heart pacemaker is placed under the skin in the chest or stomach area. This is connected to wires with electrodes that are inserted into specific areas of the brain. When the device is switched on, the electrodes deliver high-frequency electrical stimulation to the specific brain areas.
How Does Deep Brain Stimulation Help Parkinson’s?
Deep brain stimulation doesn’t cure Parkinson’s, but it can help some of the movement symptoms. It works by electrically stimulating specific brain areas that control movement.
Research shows that it improves movement and quality of life. Despite it being initially expensive to set up, it is also cost-effective in the long term, thanks to these movement improvements.
Why Can a Person Stay Awake During Deep Brain Stimulation?
The brain does not have pain nerve endings, so pain is not felt deep inside. Local anesthetic (painkiller injection) is given for the skull area, so that pain is not felt there.
What Is the Difference Between Awake Deep Brain Stimulation and Asleep Deep Brain Stimulation?
The following table lists some of the differences in medical techniques and patient experience:
| Awake Deep Brain Stimulation | Asleep Deep Brain Stimulation |
|---|---|
| The patient is conscious, but given painkillers and relaxant medicines. | The patient is unconscious, with a general anesthetic. |
| The patient is in control of their movement. Medical staff check that the electrodes are in the correct place by observing the patient’s movement. | The electrode positions are checked using medical imaging machines, which show electrical pathways in the brain that control movement. |
| Can take several hours, or a whole day. | Faster, because medical staff are not distracted with patient communication. |
| A small number of patients experience pain, despite painkillers being given. | The patient has a general anesthetic, so that they are fully unconscious and feel no discomfort. |
| The patient can feel uncomfortable or scared, because the procedure takes a long time. | The patient is unconscious during the procedure, so does not have to worry. |
| The patient can become very tired, which can make test movements harder. | Movement testing is done by machines, so patient tiredness is not a problem. |
| Sedation is faster and easier to recover from. | A general anesthetic may cause complications during recovery. |
How Did the Researchers Compare the Two Methods?
The researchers performed a systematic review and meta-analysis. They searched research databases for all research on patients undergoing deep brain stimulation for Parkinson’s. There are international guidelines for how to do this in the best way, such as using key search words to find suitable papers and using logical processes to categorize the different types of research.
The authors selected only the best and most relevant research: This resulted in information on 1,900 patients from 19 studies.
The researchers used statistical methods to analyze the combined study results for clinical effectiveness and complications of awake and asleep deep brain stimulation. They considered factors such as type of anesthesia, patient’s quality of life, medication doses, and specialist Parkinson’s assessments.
What Did This Study Show?
The results showed no significant difference in complications between the awake and asleep group. However, they concluded that asleep deep brain stimulation may be a better option, because it is more comfortable for the patient.
Note: Additional information on Parkinson’s was sourced from the charity “Parkinson’s UK”. If you have any concerns about any symptoms, you should speak to a medical professional.
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