Objective: To study the impact of the absence of awake clinical evaluation during subthalamic nucleus (STN) deep brain stimulation (DBS) on parameters of stimulation and clinical outcome for Parkinson’s disease (PD) patients.

Background: STN-DBS is usually performed while the patient is awake to ensure accurate electrophysiological mapping and clinical evaluation.To improve patient comfort and minimize the risk of adverse events, several centers perform STN-DBS implantation under general anesthesia (GA). The best surgical procedure remains a subject of debate.

Methods: 13 PD patients who underwent bilateral STN-DBS under general anaesthesia (GA) with a minimal intraoperative evaluation (patients kept asleep, side effects only), were compared to 10 patients operated under local anaesthesia (LA) with a complete testing. All surgical procedures were performed with robot Rosa coupled with a flat planel CT (fpCT) device. All patients had intraoperative microelectrode recording (MER) of the STN. The primary endpoint was the therapeutic window between the mean threshold of intensity for motor improvement and the mean threshold of intensity for stimulation side effects, on the active contacts at 1 year post-operative, expressed in volts (V). Motor disability scores were also measured.

Results: Mean intensity of stimulation was equivalent between the 2 groups, on left STN (2.23 +/- 0.89 V in the LA group) versus (2.41 +/- 0.43V in the GA group) (p= 0.22) and on right STN (2.26 +/- 0.75 V in the LA group) versus (2.66 +/- 0.57 V in the GA group) (p=0.92). The stimulation thresholds were also equivalent between the 2 groups on both STN. The mean therapeutic window on the right STN was 2.06 V in the LA group and 2.4 V in the GA group (p= 0.316). For the left STN, it was 2.06 V in the LA group vs 2.16V in the GA group (p=0.811). Motor disability scores improved in both groups.

Conclusions: Stimulation thresholds seem not to be altered by the absence of complete intraoperative clinical testing, if MRI techniques enable an accurate STN identification. The therapeutic range between the threshold of intensity for motor improvement and the threshold of stimulation side effects may indirectly reflect the accuracy of targeting.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/is-awake-intraoperative-mapping-still-necessary-for-bilateral-subthalamic-stimulation-for-parkinsons-disease-in-a-modern-surgical-environment/