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LETTER TO THE EDITOR

Nerve Stimulator-Guided Brachial Plexus Block in a Patient with Severe Parkinson's Disease and Bilateral Deep Brain Stimulators

Vincent Minville, MD^*, Clément Chassery, MD^*, Amina Benhaoua, MD^*, Vincent Lubrano, MD, Pierre Albaladejo, MD, PhD, and Olivier Fourcade, MD, PhD^*

Departments of *Anesthesiology and Intensive Care and Neurosurgery, Toulouse University Hospital, Paul Sabatier University, Toulouse, France, vincentminville{at}yahoo.fr, Department of Anesthesiology and Intensive Care, Henri Mondor University Hospital, Créteil, France

To the Editor:

Increasing numbers of patients with Parkinson's disease (PD) are being treated with an implanted cerebral stimulator (1–3). Anesthetic management of these patients is still a matter of debate (4,5). Regional anesthesia probably avoids exacerbation of PD (6). However, there are no data on whether the use of a nerve stimulator for regional anesthesia interferes with the function of the deep-brain stimulator.

We report the case of a 72-yr-old patient with a dislocated shoulder, who had deep-brain stimulators of the subthalamic nucleus (Kinetra; Medtronic, Minneapolis, MN) (Fig. 1) for a severe PD. Anesthesia was provided with a supraclavicular brachial plexus block, guided with a nerve stimulator. The Unified Parkinson Disease Rating Scale was at 28 before the surgery with axial dyskinesia and severe dysarthria. Before the procedure, the subthalamic stimulator setting was checked by the neurosurgical team. The stimulator ran throughout the procedure. Landmarks were not modified by the device, and the stimulation wires were palpated far from the puncture site. The tremor from PD did not interfere with monitoring or with placement of the block. After the procedure, the neurosurgical team reassessed the subthalamic stimulators, and found no change. The patient was discharged 2 days later from the hospital. No exacerbation of the PD was noticed (Unified Parkinson Disease Rating Scale at 28).

View larger version (119K): [in this window] [in a new window]   Figure 1. Skull radiograph showing the electrodes (E) inserted in the subthalamic area.

In summary we report successful use of a nerve stimulator in a patient with advanced PD and deep-brain stimulators. We encountered no interference with deep-brain stimulation and no complications from our use of a nerve stimulator.

References

1. Benabid AL, Pollack P, Seigneuret E, et al. Chronic VIM thalamic stimulation in Parkinson's disease, essential tremor and extra-pyramidal dyskinesias. Acta Neurochir 1993;58:39–44.
2. Krack P, Limousin P, Benabid AL, Pollak P. Chronic stimulation of subthalamic nucleus improves levodopa-induced dyskinesias in Parkinson's disease. Lancet 1997;350:1676.[Web of Science][Medline]
3. The Deep-Brain Stimulation for Parkinson's Disease Study Group. Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med 2001;345:956–63.[Abstract/Free Full Text]
4. Reed AP, Han DG. Intraoperative exacerbation of Parkinson's disease. Anesth Analg 1992;75:850–3.[Free Full Text]
5. Krauss JK, Akeyson EW, Giam P, Jankovic J. Propofol-induced dyskinesias in Parkinson's disease. Anesth Analg 1996;83:420–2.[Web of Science][Medline]
6. Nicholson G, Pereira AC, Hall GM. Parkinson's disease and anaesthesia. Br J Anaesth 2002;89:904–16.[Abstract/Free Full Text]

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