When Abigail J. Rao, M.D., joined Norton Neuroscience Institute in September, she brought a technique for deep brain stimulation (DBS) surgery, in which a  patient is fully anesthetized. Dr. Rao said “asleep” DBS has many benefits, including being more comfortable for patients, who understandably often are uncomfortable with the idea of being awake during brain surgery.

“When the field first started, people thought, ‘How are we going to know we are placing the electrodes exactly where we want them to be?’” Dr. Rao said. “So they did the surgery with patients awake.”

But advancements in technology, including intraoperative magnetic resonance imaging and computed tomography scans that map the brain in 3-D, have allowed for accurate targeting. They also allow for a much quicker procedure — two hours as opposed to most of a day — which means less likelihood that the target area will shift.

Patients who are medically-refractory may be a good candidate for asleep DBS.

Clinical outcomes for asleep DBS

A study in the Nov. 7, 2017, Neurology journal compared motor and nonmotor outcomes at six months of asleep DBS for Parkinson’s disease using intraoperative imaging guidance to confirm electrode placement versus awake DBS using microelectrode recording to confirm electrode placement.

Results

Thirty participants underwent asleep DBS, and 39 had awake DBS. No difference was observed in improvement of UPDRS III (+14.8 ± 8.9 vs. +17.6 ± 12.3 points, p = 0.19) or UPDRS II (+9.3 ± 2.7 vs. +7.4 ± 5.8 points, p = 0.16). Improvement in “on” time without dyskinesia was superior in asleep DBS (+6.4 ± 3.0 h/d vs. +1.7 ± 1.2 h/d, p = 0.002). Quality of life scores improved in both groups (+18.8 ± 9.4 in awake, +8.9 ± 11.5 in asleep). Improvement in summary index (p = 0.004) and subscores for cognition (p = 0.011) and communication (p < 0.001) were superior in asleep DBS. Speech outcomes were superior in asleep DBS, both in category (+2.77 ± 4.3 points vs. −6.31 ± 9.7 points (p = 0.0012) and phonemic fluency (+1.0 ± 8.2 points vs. −5.5 ± 9.6 points, p = 0.038).

Conclusions

Asleep DBS for Parkinson’s disease improved motor outcomes over six months on par with or better than awake DBS, was superior with regard to speech fluency and quality of life, and should be an option considered for all patients who are candidates for this treatment.

Other benefits of asleep DBS

• Faster and safer (due to lower risk of hemorrhage)
• Patients can take medication on the day of surgery
• Reduces patient anxiety

Dr. Rao learned the asleep DBS technique from Kim Burchiel, M.D., who pioneered the procedure. Dr. Rao is excited to bring it to Norton Neuroscience Institute.

Patient referral

Make a referral to Norton Neuroscience Institute’s Parkinson’s disease program.