PRO: General Anesthesia for Deep Brain Stimulator Insertion in Patients With Parkinson Disease

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Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) is one of the most effective treatments for advanced idiopathic Parkinson disease (PD).1 The degree of clinical improvement achieved by means of DBS is largely dependent on careful patient selection and precise target localization using both neuroimaging techniques and intraoperative electrophysiology. Insertion of DBS electrodes is commonly performed under local anesthesia (LA) with or without sedation to facilitate intraoperative neurophysiological testing and until recently this was the preferred method.2 With the patient awake and in a “drug-off” state reliable microelectrode recordings (MER) can be obtained. The evaluation of intraoperative stimulation-induced improvement in parkinsonian signs and dyskinesia, as well as observation of any possible adverse effects caused by the diffusion of current to adjacent structures such as the internal capsule or medial lemniscus is possible.

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