Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA.
Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, USA.
J Neurol Neurosurg Psychiatry. 2018 Jul;89(7):687-691. doi: 10.1136/jnnp-2016-314500. Epub 2017 Mar 1.
No definitive comparative studies of the efficacy of 'awake' deep brain stimulation (DBS) for Parkinson's disease (PD) under local or general anaesthesia exist, and there remains significant debate within the field regarding differences in outcomes between these two techniques.
We conducted a literature review and meta-analysis of all published DBS for PD studies (n=2563) on PubMed from January 2004 to November 2015. Inclusion criteria included patient number >15, report of precision and/or clinical outcomes data, and at least 6 months of follow-up. There were 145 studies, 16 of which were under general anaesthesia. Data were pooled using an inverse-variance weighted, random effects meta-analytic model for observational data.
There was no significant difference in mean target error between local and general anaesthesia, but there was a significantly less mean number of DBS lead passes with general anaesthesia (p=0.006). There were also significant decreases in DBS complications, with fewer intracerebral haemorrhages and infections with general anaesthesia (p<0.001). There were no significant differences in Unified Parkinson's Disease Rating Scale (UPDRS) Section II scores off medication, UPDRS III scores off and on medication or levodopa equivalent doses between the two techniques. Awake DBS cohorts had a significantly greater decrease in treatment-related side effects as measured by the UPDRS IV off medication score (78.4% awake vs 59.7% asleep, p=0.022).
Our meta-analysis demonstrates that while DBS under general anaesthesia may lead to lower complication rates overall, awake DBS may lead to less treatment-induced side effects. Nevertheless, there were no significant differences in clinical motor outcomes between the two techniques. Thus, DBS under general anaesthesia can be considered at experienced centres in patients who are not candidates for traditional awake DBS or prefer the asleep alternative.
在局部或全身麻醉下进行“清醒”深部脑刺激（DBS）治疗帕金森病（PD）的疗效比较研究尚无定论，并且该领域内对于这两种技术之间的结果差异仍存在较大争议。
我们对 2004 年 1 月至 2015 年 11 月在 PubMed 上发表的所有 PD 患者 DBS 研究（n=2563）进行了文献复习和荟萃分析。纳入标准包括患者数量>15，报告精度和/或临床结果数据，以及至少 6 个月的随访。共有 145 项研究，其中 16 项为全身麻醉。采用逆方差加权、随机效应荟萃分析模型对观察数据进行数据合并。
局部麻醉和全身麻醉的平均靶点误差无显著差异，但全身麻醉的 DBS 导联通过数量明显减少（p=0.006）。全身麻醉的 DBS 并发症也显著减少，颅内出血和感染更少（p<0.001）。两种技术之间，药物治疗前后的帕金森病评定量表（UPDRS）第二部分评分、药物治疗前后的 UPDRS 第三部分评分和左旋多巴等效剂量均无显著差异。与药物治疗相关的副作用（通过 UPDRS 第四部分评分评估）方面，清醒 DBS 队列的下降幅度显著更大（清醒组 78.4%，睡眠组 59.7%，p=0.022）。
我们的荟萃分析表明，尽管全身麻醉下的 DBS 可能总体上导致较低的并发症发生率，但清醒 DBS 可能导致较少的治疗诱导副作用。然而，两种技术之间的临床运动结果没有显著差异。因此，在经验丰富的中心，对于不符合传统清醒 DBS 条件或更倾向于全身麻醉的患者，可以考虑全身麻醉下的 DBS。
