Objective: We retrospectively compared quality of life and functional status metrics to assess differences among patients who underwent implantation of Deep Brain Stimulation (DBS) for Parkinson’s disease (PD) or Dystonia via either awake or asleep surgery.

Background: DBS surgery has been performed using light sedation to allow use of intra-operative microelectrode recording to guide electrode placement (“awake” surgery). High-resolution, intra-operative imaging has provided a method for high-accuracy electrode placement under general anesthesia (“asleep” surgery). Initial comparisons between awake and asleep DBS surgery in PD have shown similar outcomes in lead positioning and clinical scales [1] [2]. Outcome studies comparing awake and asleep DBS surgical techniques for dystonia or longer-term outcomes in PD are limited.

Method: We performed a retrospective review of outcomes in patients implanted with DBS electrodes either awake or asleep in the subthalamic nucleus (STN) or globus pallidus internus (GPi) for PD or dystonia by a single surgeon. We used a modified Euro-QoL-5D-5L survey to compare patient impressions among awake vs asleep cohorts of the surgical experience and impact of DBS on quality of life. We performed a chart review to assess differences among awake vs asleep cohorts across a variety of clinical metrics pre- and post-surgery such as clinical scales, medication equivalent doses, and DBS programming parameters; we included 6, 12, and 24 month time points as available.

Results: Preliminary results showed no significant differences across awake and asleep groups in the degree to which DBS improved functional outcomes. Across groups, patients had significant improvements in performing work/leisure activities and pain after DBS surgery. Patients with either awake or asleep STN DBS reported significant improvement in ability to walk post-DBS. The asleep STN cohort reported fewer side effects from DBS than the awake STN cohort with a similar trend in the GPi cohorts. Patients who underwent asleep STN DBS reported a better surgical experience than the awake STN cohort. However, patients were equally likely to choose to undergo DBS again.

Conclusion: Our results suggest similar patient functional and quality of life outcomes with asleep or awake surgery, though patients who had asleep surgery reported a better surgical experience.

References: [1] M. A. Brodsky, S. Anderson, C. Murchison, M. Seier, J. Wilhelm, A. Vederman and K. J. Burchiel, “Clinical outcomes of asleep vs awake deep brain stimulation for Parkinson disease,” Neurology, vol. 89, no. 19, pp. 1944-1950, November 2017.
[2] A. L. Ho, R. Ali, I. D. Connolly, J. M. Henderson, R. Dhall, S. C. Stein and C. H. Halpern, “Awake versus asleep deep brain stimulation for Parkinson’s disease: a critical comparison and meta-analysis,” Journal of Neurology, Neurosurgery, and Psychiatry, vol. 89, pp. 687-691, 2018.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-retrospective-comparison-of-functional-and-quality-of-life-outcomes-in-dbs-patients-implanted-via-awake-or-asleep-surgery-the-rush-university-medical-center-experience/