217 Clinical Outcomes Following Awake and Asleep Deep Brain Stimulation for Parkinson's Disease

Abstract

Abstract INTRODUCTION Recent studies show similar clinical outcomes in Parkinson's disease (PD) patients treated by deep brain stimulation (DBS) under general anesthesia without microelectrode recording (MER), so-called “asleep” DBS, compared to historical cohorts undergoing “awake” DBS with MER guidance. Very few studies, however, include internal controls. This study compares clinical outcomes following globus pallidus interna (GPi) and subthalamic nucleus (STN) DBS using awake and asleep techniques at a single institution. METHODS PD patients undergoing awake or asleep bilateral GPi or STN DBS were prospectively followed. The primary outcome measure was stimulation-induced change in motor function 6 months postoperatively, measured by the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) with the patient off medication. Secondary outcomes included change in quality of life, measured by the 39-item Parkinson's Disease Questionnaire (PDQ-39), change in levodopa daily equivalent dose (LEDD), stereotactic accuracy, stimulation parameters, and adverse events. RESULTS >Six-month outcome data were available for 133 patients treated over 45 months (78 GPi [16 awake, 62 asleep] and 55 STN [14 awake and 41 asleep]). UPDRS-III score improvement with stimulation did not differ between awake and asleep groups for GPi (awake = 20.8 points [38.5%], asleeP = 18.8 points [37.5%], P = 0.45) or STN (awake = 21.6 points [40.3%], asleeP = 26.1 points [48.8%], P = 0.20) targets. The percentage improvement in PDQ-39 and LEDD was similar for awake and asleep groups for both GPi (P = 0.80, P = 0.54, respectively) and STN cohorts (P = 0.85, P = 0.49, respectively). CONCLUSION In PD patients, bilateral GPi and STN DBS utilizing the asleep method resulted in motor, quality-of-life, and medication reduction outcomes comparable to the awake method.