Better Quality of Life and Communication Outcomes After Asleep vs. Awake Placement of Deep Brain Stimulator


In this study, 39 patients underwent standard subthalamic nucelus or globus pallidus pars interna DBS targeting via an awake surgery with micro-electrode recording (historical cohort). Another 30 patients underwent DBS under general anesthesia, guided by intra-operative CT fused to pre-operative MRI.  Motor outcomes, measured by the Unified Parkinson’s Disease Rating Scale (UPDRS) part III, were not different between groups.  UPDRS II improvement in activities of daily living (ADLs) were not different. Target choice was not significant for any measure. Motor diaries revealed that asleep surgery patients had significantly greater “on” time without dyskinesias (6.4 +/- 3.0 h/d) and less “on” time with dyskinesias  (3.5 +/- 3.7 h/d) compared to the awake group (1.7 +/- 1.2 h/ d and 0.9 +/- 1.0 h/d, respectively) (p < 0.01). Asleep surgery patients also experienced a greater decrease in “off” time compared to awake surgery patients. Parkinson’s Disease Questionnaire (PDQ-39) Quality of Life measures was significantly improved in the asleep cohort vs. the awake cohort, specifically due to relative improvements in cognition and communication sub-scores. Category fluency improved on the Controlled Oral Word Association Test by 2.77 +/- 4.3 in the asleep group, but decreased by 6.31 +/- 9.7 in the awake group.  Cognition remained stable in both groups on the Matthis Dementia Rating Scale. In this single center single surgeon study, 6 month outcomes were better in patients who underwent asleep DBS vs. awake DBS.

Ellen L. Air, MD, PhD
Detroit, MI