Anesthesia for patients with movement disorders

PURPOSE OF REVIEW: This review discusses the anesthetic management of patients with movement disorders, including those undergoing nonneurologic surgery, those undergoing deep brain stimulation surgery, and the perioperative care of individuals with deep brain stimulators. RECENT FINDINGS: Safe anesthesia in patients with movement disorders aims to preserve baseline neurologic function and prevent perioperative worsening of symptoms. Key elements include identifying the specific movement disorder, understanding functional limitations and comorbidities, and managing chronic medications regardless of the surgical procedure. In deep brain stimulation surgery, anesthetic practice has evolved from predominantly "awake" techniques to a patient-centered approach that may involve awake surgery, monitored sedation, or general anesthesia. Technological advances such as high-resolution imaging, robotic assistance, and intraoperative computed tomography or MRI have improved targeting accuracy and expanded the feasibility and safety of asleep deep brain stimulation. Additionally, anesthesiologists increasingly care for patients with existing deep brain stimulation systems, which requires vigilance to prevent electromagnetic interference or electrical conduction that could impair device function or harm brain tissue near the electrodes. SUMMARY: Anesthetic care for patients with movement disorders spans a broad clinical spectrum, from routine surgery to deep brain stimulation implantation and subsequent procedures in patients with implanted devices. Optimal outcomes depend on multidisciplinary collaboration, individualized anesthetic planning, and meticulous perioperative management to minimize neurologic and device-related complications.