Objective: To evaluate neuropsychological outcome of bilateral GPi DBS carried out under general anesthesia using a combination of direct anatomical targeting and intraoperative computed tomography (IOCT).

Background: Neurobehavioral outcomes of GPi DBS in PD using microelectrode recording during "awake" surgery have been infrequently reported but the procedure is safe, mostly producing only mild decrements in verbal fluency. Neurobehavioral outcomes have not been reported for the surgical procedure using direct targeting, IOCT and general anesthesia.

Methods: Patients with PD (free of dementia or untreated psychiatric illness) underwent neuropsychological evaluation (NP) before and about 6 months after surgery. NP included tests of intelligence, level of cognitive functioning, attention, executive and visuoperceptual functions, language, memory, and scales of quality of life (QoL), depression, apathy, anxiety, impulsive and compulsive behaviors, and daytime sleepiness. Scores were compared by t-tests. Multiple comparison correction was not made given primary interest in safety and thus greater aversion to Type II than Type I error. Individual outcome was evaluated via frequency count of 1 and 2 standard deviation (SD) score changes. Targeting and surgical procedure have been described (Mirzadeh et al., 2015). Choice of "asleep" surgery was based on patient preference, informed consent and referring neurologist’s approval.

Results: 22 patients (14 males, 8 females; 20 right- and 2 left-handed) had mean age of 63.4 years, education 14.9 years and disease duration 10.7 years. Motor outcomes have been reported. Statistically significant improvement occurred in visual confrontation naming (1+ SD in 32%), anxiety, and bodily discomfort. The most common improvements were observed in psychomotor speed and attention switching whilst the most common declines were seen in delayed recall of word lists and designs. Mean satisfaction with cognition and communication did not change significantly.

Conclusions: "Asleep" GPi DBS appears relatively safe neuropsychologically. A minority of patients experiences improvements in naming or decrements in memory. QoL ratings relating to cognition and communication are not impacted. Direct comparisons of awake and asleep procedures are needed, as are studies of outcomes in persons with and without various mild cognitive impairment (MCI) subtypes.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neuropsychological-safety-of-bilateral-pallidal-gpi-deep-brain-stimulation-dbs-for-parkinsons-disease-pd-under-general-anesthesia/