November 30, 2017
In patients with Parkinson disease who undergo deep brain stimulation (DBS) surgery to ease symptoms, those who have the procedure while asleep rather than awake may experience better clinical outcomes.
A new study published in Neurology by Matthew Brodsky, MD, Oregon Health & Science University (OHSU) School of Medicine, and colleagues conducted a clinical outcome trial in 69 people who underwent DBS surgery at OHSU, comparing those who were awake with those who were asleep during the surgery.
Although DBS can greatly improve motor function, loss of speech fluency is a common side effect. Dr Brodsky and his team hypothesized that this effect on speech may be linked to the fact that patients were asleep during the procedure. The waking version of the procedure involves the use of microelectrode recording (MER) to identify the target for placing the stimulating electrode within the brain. The patient needs to be awake to answer questions and validate effectiveness. However, these microelectrodes effectively require the neurosurgeon to send probes into the brain at least twice—once to map the territory with the MER and once to place the battery-powered electrode that will be left in the brain. Whereas in “asleep-DBS” there is only a “single pass” into the brain.
Thirty participants underwent asleep DBS, and 39 underwent awake DBS. No difference was observed in improvement of UPDRS III or UPDRS II. Improvement in “on” time without dyskinesia was superior in asleep DBS. Quality-of-life scores improved in both groups. Improvement in summary index and subscores for cognition and communication were superior in asleep DBS. Speech outcomes were superior in asleep DBS, both in category and phonemic fluency (2017; doi:10.1212/WNL.0000000000004630).
Dr Brodsky summarized the results: “Patients undergoing asleep-DBS had improved speech versus patients undergoing awake DBS, whose speech fluency predictably worsened.” In an accompanying editorial published alongside the study, authors commented, “Eliminating MER will reduce risks without compromising outcomes, shorten the procedure duration, and reduce its costs…. Asleep surgery is certainly better for patients.”
—Amanda Del Signore
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