Objective: To determine trends and perceptions regarding Asleep and Awake Deep Brain Stimulation (DBS) in the USA and abroad.

Background: DBS clinical practice continues to evolve leading to a wide variability in intraoperative methods, and consensus regarding optimal workflow is lacking.

Method: A panel of DBS clinicians created a REDCap survey regarding DBS practice in the US and abroad. The survey was sent out to the Functional Neurosurgery Working Group of the Parkinson Study Group, DBS Think Tank, World Society for Stereotactic and Functional Neurosurgery, and Movement Disorder Society members with stated DBS interest.

Results: There were 321 individual respondents from 38 countries and six continents. Sixty percent were neurosurgeons, 37% neurologists and 3% Advanced Practice Providers. Fifty-eight percent perform both awake and asleep DBS procedures, 26.8% awake only, and 15.5% asleep only. Of 117 centers performing both awake and asleep DBS, 70% choose awake for STN, 45% choose awake for GPi, and 92% choose awake for VIM. When asked to agree or disagree to: “asleep DBS is equal to or more effective than awake DBS,” for VIM 12.7% agree and 60.6% disagree, for GPi 57.4% agree and 23.8% disagree, and for STN 29.4% agree and 41.3% disagree (remainder ‘similar’ or ‘no experience’). Of 162 respondents who perform asleep DBS, 21.6% use intra-operative MRI (iMRI). Out of the 78.4% who do not use iMRI for asleep DBS, 54.3% use microelectrode recording (MER). Of 187 respondents who perform awake DBS, the most commonly used tools reported were: pre-op MRI (95.2%), MER (91.4%) and test stimulation (stim, 95.1%). When presented with 7 techniques for awake/asleep DBS, the choice for the “Most optimal technique for each target,” was ‘awake+MER+stimulation+/-intraoperative imaging’ for STN and VIM. For GPi, ‘Asleep i-MRI’ and ‘awake+MER+stimulation+/-intraoperative imaging’ received a similar number of responses. For the “Least optimal technique for each target,” respondents chose ‘asleep iCT/Oarm’ for STN, GPi and VIM.

Conclusion: Results confirmed high variability in the use of intraoperative methods. There was a preference for the use of Awake DBS for VIM and STN, while the results for GPi were equivocal. These results provide only a snapshot of current DBS trends, and perceptions may change with further technological advances.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-trends-and-clinician-perceptions-regarding-asleep-and-awake-dbs/