Raoul Sylvie, Brissot Régine, Lefaucheur Jean-Pascal, Nguyen Jean-Michel, Rouaud Tiphaine, Meas Yunsan, Huchet Alain, Razafimahefa Ndrianaina, Damier Philippe, Nizard Julien, Nguyen Jean-Paul
Service de Neurochirurgie, Hôpital Laennec, CHU, 44093 Nantes, France.
EA4391, Excitabilité Nerveuse et Thérapeutique, Université Paris Est Créteil, 94000 Créteil, France.
J Clin Med. 2022 May 10;11(10):2680. doi: 10.3390/jcm11102680.
Deep brain stimulation (DBS) is an effective technique to treat patients with advanced Parkinson's disease. The surgical procedure of DBS implantation is generally performed under local anesthesia due to the need for intraoperative clinical testing. However, this procedure is long (5-7 h on average) and, therefore, the objective that the patient remains co-operative and tolerates the intervention well is a real challenge.
To evaluate the additional benefit of electroacupuncture (EA) performed intraoperatively to improve the comfort of parkinsonian patients during surgical DBS implantation.
This single-center randomized study compared two groups of patients. In the first group, DBS implantation was performed under local anesthesia alone, while the second group received EA in addition. The patients were evaluated preoperatively, during the different stages of the surgery, and 2 days after surgery, using the 9-item Edmonton Symptom Assessment System (ESAS), including a total sum score and physical and emotional subscores.
The data of nine patients were analyzed in each group. Although pain and tiredness increased in both groups after placement of the stereotactic frame, the ESAS item "lack of appetite", as well as the ESAS total score and physical subscore increased after completion of the first burr hole until the end of the surgical procedure in the control group only. ESAS total score and physical subscore were significantly higher at the end of the intervention in the control group compared to the EA group. After the surgical intervention (D2), anxiety and ESAS emotional subscore were improved in both groups, but the feeling of wellbeing improved in the EA group only. Finally, one patient developed delirium during the intervention and none in the EA group.
This study shows that intraoperative electroacupuncture significantly improves the tolerance of DBS surgery in parkinsonian patients. This easy-to-perform procedure could be fruitfully added in clinical practice.
深部脑刺激（DBS）是治疗晚期帕金森病患者的一种有效技术。由于术中需要进行临床测试，DBS植入手术通常在局部麻醉下进行。然而，该手术时间较长（平均5 - 7小时），因此，让患者保持合作并良好耐受干预是一项真正的挑战。
评估术中进行电针（EA）以提高帕金森病患者在DBS植入手术期间舒适度的额外益处。
这项单中心随机研究比较了两组患者。第一组仅在局部麻醉下进行DBS植入，而第二组额外接受电针治疗。在术前、手术的不同阶段以及术后2天，使用9项埃德蒙顿症状评估系统（ESAS）对患者进行评估，包括总分以及身体和情绪子分数。
每组分析了9例患者的数据。虽然在放置立体定向框架后两组的疼痛和疲劳都有所增加，但仅在对照组中，从第一个骨孔钻完到手术结束，ESAS项目“食欲不振”以及ESAS总分和身体子分数增加。与电针组相比，对照组在干预结束时ESAS总分和身体子分数显著更高。手术干预后（D2），两组的焦虑和ESAS情绪子分数均有所改善，但仅电针组的幸福感有所改善。最后，有1例患者在干预期间出现谵妄，电针组无患者出现谵妄。
本研究表明术中电针显著提高了帕金森病患者对DBS手术的耐受性。这种易于实施的方法可在临床实践中有效应用。
