Patients do not need to stay awake during Parkinson's surgery, research shows

The brain operations some patients with Parkinson's disease undergo often requires the patient to remain awake, but it can also be performed under general anesthesia, according to PhD candidate Saman Vinke from the Radboudumc in Nijmegen. This also makes it possible to perform two operations in a single day instead of one. Additionally. women also seem more likely to opt for the treatment if it can be carried out under anesthesia.

The symptoms associated with Parkinson's disease, such as tremors, sluggishness and stiffness, can be relieved by "deep brain stimulation." In this procedure, electrodes are implanted in a deep area of the brain through small holes in the skull. The implants are capable of sending out electrical impulses. In the Netherlands, about 300 of these operations are performed each year.

Usually, the patient is mostly awake during the procedure. The surgeon looks for the right place in the brain to place the electrodes by delivering small electrical pulses. To determine if the right spot has been found, the doctor checks whether the patient's symptoms disappear, Vinke explained.

Overall, The procedure takes almost a full day of work, and the patient's head is immobilized for a long time. In addition, the patient must temporarily stop taking his or her medications, which can worsen symptoms before surgery.

Vinke examined whether an MRI scan could find the right position in the brain just as well. This would make the surgery duration shorter and allow patients to continue taking their medications as usual. For the study, 123 patients underwent surgery, some while awake and others under anesthesia. To verify the conclusions, data from about 650 patients from abroad were also examined.

When told the operation can be performed under anesthesia when an MRI scan is used, more and more women opt for this method. Vinke explained, "Parkinson's occurs in 40 percent of cases in women. However, in our study, only 17 percent of patients with the traditional surgical method were women. Since we started operating under anesthesia, that percentage has risen to more than 40 percent, which is how the disease is distributed in the population.”

However, the PhD candidate does not know why women are less likely to volunteer to undergo surgery while remaining awake. That is still being studied. At Radboudumc, deep brain stimulation surgeries are now performed only with an MRI scan and under anesthesia.