Association of clinical outcomes and connectivity in awake versus asleep deep brain stimulation for Parkinson disease

• DOI: 10.3171/2022.6.jns212904
• Publication Date: 2022-08-05T13:07:25Z
• Authors: Ron Gadot; Nora Vanegas Arro...; Huy Dang; Adrish Anand; Ricardo A. Najera; Lisa Yutong Taneff; Steven Bellows; Arjun Tarakad; Joseph Jankovic; Andreas Horn; Ben Shofty; Ashwin Viswanathan; Sameer A. Sheth
• Keywords: Association (psychology)

Deep brain stimulation (DBS) for Parkinson disease (PD) is traditionally performed with awake intraoperative testing and/or microelectrode recording. Recently, however, the procedure has been increasingly under general anesthesia image-based verification. The authors sought to compare structural and functional networks engaged by asleep PD-DBS of subthalamic nucleus (STN) correlate them clinical outcomes.Levodopa equivalent daily dose (LEDD), pre- postoperative motor scores on Movement Disorders Society-Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III), total electrical energy delivered (TEED) at 6 months were retroactively assessed in patients PD who received implants bilateral DBS leads. In subset analysis, implanted electrodes reconstructed using Lead-DBS toolbox. Volumes tissue activated (VTAs) used as seed points group volumetric connectivity analysis.The courses 122 (52 asleep, 70 awake) reviewed. Operating room times significantly shorter cases. LEDD reduction, MDS-UPDRS score improvement, TEED 6-month follow-up did not differ between groups. analysis (n = 40), proximity active contact, VTA overlap, desired network fiber counts STN correlated lower requirement improved scores. Discriminative tracts involving supplementary area, thalamus, brainstem associated optimal improvement. Areas highest VTAs two groups.Compared DBS, procedures can achieve similarly targeting-based outcomes, electrode placement, estimates-in more efficient operating times.