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Clinical outcomes following awake and asleep deep brain stimulation for Parkinson disease.
J Neurosurg. 2018 03 16; 130(1):109-120.JN

Abstract

OBJECTIVE

Recent studies have shown similar clinical outcomes between Parkinson disease (PD) patients treated with deep brain stimulation (DBS) under general anesthesia without microelectrode recording (MER), so-called “asleep” DBS, and historical cohorts undergoing “awake” DBS with MER guidance. However, few studies include internal controls. This study aims to compare clinical outcomes after globus pallidus internus (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 monitored. The primary outcome measure was stimulation-induced change in motor function off medication 6 months postoperatively, measured using the Unified Parkinson’s Disease Rating Scale part III (UPDRS-III). Secondary outcomes included change in quality of life, measured by the 39-item Parkinson’s Disease Questionnaire (PDQ-39), change in levodopa equivalent daily dosage (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, 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 and p = 0.54, respectively) and STN cohorts (p = 0.85 and p = 0.49, respectively).

CONCLUSIONS

In PD patients, bilateral GPi and STN DBS using the asleep method resulted in motor, quality-of-life, and medication reduction outcomes that were comparable to those of the awake method.

Authors+Show Affiliations

Departments of1Neurosurgery.Departments of1Neurosurgery.Departments of1Neurosurgery.Departments of1Neurosurgery.2Neurology, and.2Neurology, and.3Clinical Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and.4Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.Departments of1Neurosurgery.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29547091

Citation

Chen, Tsinsue, et al. "Clinical Outcomes Following Awake and Asleep Deep Brain Stimulation for Parkinson Disease." Journal of Neurosurgery, vol. 130, no. 1, 2018, pp. 109-120.
Chen T, Mirzadeh Z, Chapple KM, et al. Clinical outcomes following awake and asleep deep brain stimulation for Parkinson disease. J Neurosurg. 2018;130(1):109-120.
Chen, T., Mirzadeh, Z., Chapple, K. M., Lambert, M., Shill, H. A., Moguel-Cobos, G., Tröster, A. I., Dhall, R., & Ponce, F. A. (2018). Clinical outcomes following awake and asleep deep brain stimulation for Parkinson disease. Journal of Neurosurgery, 130(1), 109-120. https://doi.org/10.3171/2017.8.JNS17883
Chen T, et al. Clinical Outcomes Following Awake and Asleep Deep Brain Stimulation for Parkinson Disease. J Neurosurg. 2018 03 16;130(1):109-120. PubMed PMID: 29547091.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical outcomes following awake and asleep deep brain stimulation for Parkinson disease. AU - Chen,Tsinsue, AU - Mirzadeh,Zaman, AU - Chapple,Kristina M, AU - Lambert,Margaret, AU - Shill,Holly A, AU - Moguel-Cobos,Guillermo, AU - Tröster,Alexander I, AU - Dhall,Rohit, AU - Ponce,Francisco A, PY - 2017/04/07/received PY - 2017/08/21/accepted PY - 2018/3/17/pubmed PY - 2019/10/19/medline PY - 2018/3/17/entrez KW - DBS = deep brain stimulation KW - GPi = globus pallidus internus KW - LEDD = levodopa equivalent daily dosage KW - MER = microelectrode recording KW - OFF/OFF = off medication KW - OFF/ON = off medication KW - ON/ON = on medication KW - OR = operating room KW - PD = Parkinson disease KW - PDQ-39 KW - PDQ-39 = 39-item Parkinson’s Disease Questionnaire KW - Parkinson disease KW - SI = single index KW - STN = subthalamic nucleus KW - UPDRS-III = Unified Parkinson’s Disease Rating Scale part III KW - Unified Parkinson’s Disease Rating Scale KW - asleep DBS KW - clinical outcomes KW - deep brain stimulation KW - functional neurosurgery KW - general anesthesia KW - iCT = intraoperative CT KW - intraoperative imaging KW - levodopa equivalent daily dosage KW - off stimulation KW - on stimulation KW - stereotactic accuracy SP - 109 EP - 120 JF - Journal of neurosurgery JO - J Neurosurg VL - 130 IS - 1 N2 - OBJECTIVE: Recent studies have shown similar clinical outcomes between Parkinson disease (PD) patients treated with deep brain stimulation (DBS) under general anesthesia without microelectrode recording (MER), so-called “asleep” DBS, and historical cohorts undergoing “awake” DBS with MER guidance. However, few studies include internal controls. This study aims to compare clinical outcomes after globus pallidus internus (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 monitored. The primary outcome measure was stimulation-induced change in motor function off medication 6 months postoperatively, measured using the Unified Parkinson’s Disease Rating Scale part III (UPDRS-III). Secondary outcomes included change in quality of life, measured by the 39-item Parkinson’s Disease Questionnaire (PDQ-39), change in levodopa equivalent daily dosage (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, 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 and p = 0.54, respectively) and STN cohorts (p = 0.85 and p = 0.49, respectively). CONCLUSIONS: In PD patients, bilateral GPi and STN DBS using the asleep method resulted in motor, quality-of-life, and medication reduction outcomes that were comparable to those of the awake method. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/29547091/Clinical_outcomes_following_awake_and_asleep_deep_brain_stimulation_for_Parkinson_disease_ L2 - https://thejns.org/doi/10.3171/2017.8.JNS17883 DB - PRIME DP - Unbound Medicine ER -