Factors influencing the reliability of intraoperative testing in deep brain stimulation for Parkinson’s disease

Background Several meta-analyses comparing the outcome of awake versus asleep deep brain stimulation procedures could not reveal significant differences concerning the postoperative improvement of motor symptoms. Only rarely information on the procedural details is provided for awake operations and how often somnolence and disorientation occurred, which might hamper the reliability of intraoperative clinical testing. The aim of our study was to investigate possible influencing factors on the occurrence of somnolence and disorientation in awake DBS procedures. Methods We retrospectively analyzed 122 patients with Parkinson's disease having received implantation of a DBS system at our centre. Correlation analyses were performed for the duration of disease prior to surgery, number of microelectrode trajectories, AC-PC-coordinates of the planned target, UPDRS-scores, intraoperative application of sedative drugs, duration of the surgical procedure, perioperative application of apomorphine, and the preoperative L-DOPA equivalence dosage with the occurrence of intraoperative somnolence and disorientation. Results Patients with intraoperative somnolence were significantly older (p=0.039). Increased duration of the DBS procedure (p=0.020), delayed start of the surgery (p=0.049), higher number of MER trajectories (p=0.041), and the patients’ % UPDRS improvement (p=0.046) also correlated with the incidence of intraoperative somnolence. We identified the main contributing factor to intraoperative somnolence as the use of sedative drugs applied during skin incision and burr hole trepanation (p=0.019). Perioperatively applied apomorphine could reduce the occurrence of somnolent phases during the operation (p=0.026). Conclusion Several influencing factors were found to seemingly increase the risk of intraoperative somnolence and disorientation, while the use of sedative drugs seems to be the main contributing factor. We argue that awake DBS procedures should omit the use of sedatives for best clinical outcome. When reporting on awake DBS surgery these factors should be considered and adjusted for, to permit reliable interpretation and comparison of DBS study results

Center and Periphery. Theological Perspectives on Church and Society

Krisenzeit – Zeit der Kirche – Zeit der Theologie? Die Problemlagen der Gegenwart stellen die wissenschaftliche Theologie vor so große Herausforderungen wie selten zuvor. Nicht allein stehen in den kommenden Jahren strukturelle Weichenstellungen an, welche die Kirche kaum unberührt lassen werden. Schon jetzt verlangt die prekäre Situation vieler Menschen und ganzer Völker nach einer tragfähigen Reflexion und Verkündigung des Glaubens. Christliche Theologie darf die notwendigen Antworten hier nicht schuldig bleiben. In der vorliegenden Festschrift haben sich Kollegen, Freunde und Schüler von Otmar Meuffels den vielfältigen Fragestellungen zugewandt, welche die Arbeit an der zeitgenössischen Heilsbedeutung des christlichen Glaubens aufwirft. Sie schreiben damit seinen prägenden Ansatz fort, der stets die aktuelle Relevanz der Rede von Gott im Blick hat. In diesem Sinn zeigen die in diesem Band versammelten Beiträge auf ganz unterschiedlichen Feldern die Anschlussfähigkeit der Theologie in den heute virulenten gesellschaftlichen Debatten.Time of Crisis – Times of Church – Time of Theology? Academic theology has rarely faced bigger challenges than those of the present. The coming years will see structural course changes which will leave the church hardly untouched. Even today, the precarious situation of people and people’s demands for viable reflection and proclamation of Faith. Christian theology must not fail to give necessary answers in this regard. In this publication, colleagues, friends, and students of Otmar Meuffels faced these diverse questions, which are posed by working with the contemporary soteriological significance of Christian faith. With this, they continue his defining approach which always focuses on the current relevance of the speech of God. Therefore, all contributions collected in this publication show the ability to connect theology with current and relevant societal controversies in completely different fields