Clinical outcomes following awake and asleep deep brain stimulation for Parkinson disease

Abstract

Objective: Recent studies have shown similar clinical outcomes between Parkinson disease (PD) patients treated with deep brain stimulation (DBS) under general anesthesia without microelectrode recording (MER), so-called “asleep” DBS, and historical cohorts undergoing “awake” DBS with MER guidance. However, few studies include internal controls. This study aims to compare clinical outcomes after globus pallidus internus (GPi) and subthalamic nucleus (STN) DBS using awake and asleep techniques at a single institution.

Methods: PD patients undergoing awake or asleep bilateral GPi or STN DBS were prospectively monitored. The primary outcome measure was stimulation-induced change in motor function off medication 6 months postoperatively, measured using the Unified Parkinson’s Disease Rating Scale part III (UPDRS-III). Secondary outcomes included change in quality of life, measured by the 39-item Parkinson’s Disease Questionnaire (PDQ-39), change in levodopa equivalent daily dosage (LEDD), stereotactic accuracy, stimulation parameters, and adverse events.

Results: Six-month outcome data were available for 133 patients treated over 45 months (78 GPi [16 awake, 62 asleep] and 55 STN [14 awake, 41 asleep]). UPDRS-III score improvement with stimulation did not differ between awake and asleep groups for GPi (awake, 20.8 points [38.5%]; asleep, 18.8 points [37.5%]; p = 0.45) or STN (awake, 21.6 points [40.3%]; asleep, 26.1 points [48.8%]; p = 0.20) targets. The percentage improvement in PDQ-39 and LEDD was similar for awake and asleep groups for both GPi (p = 0.80 and p = 0.54, respectively) and STN cohorts (p = 0.85 and p = 0.49, respectively).

Conclusions: In PD patients, bilateral GPi and STN DBS using the asleep method resulted in motor, quality-of-life, and medication reduction outcomes that were comparable to those of the awake method.

Keywords: DBS = deep brain stimulation; GPi = globus pallidus internus; LEDD = levodopa equivalent daily dosage; MER = microelectrode recording; OFF/OFF = off medication; OFF/ON = off medication; ON/ON = on medication; OR = operating room; PD = Parkinson disease; PDQ-39; PDQ-39 = 39-item Parkinson’s Disease Questionnaire; Parkinson disease; SI = single index; STN = subthalamic nucleus; UPDRS-III = Unified Parkinson’s Disease Rating Scale part III; Unified Parkinson’s Disease Rating Scale; asleep DBS; clinical outcomes; deep brain stimulation; functional neurosurgery; general anesthesia; iCT = intraoperative CT; intraoperative imaging; levodopa equivalent daily dosage; off stimulation; on stimulation; stereotactic accuracy.