Deep Brain Stimulation in Awake and Asleep Patients: A Case Series

Introduction: Deep brain stimulation (DBS) is a neurosurgical procedure that implants electrodes into discrete neuroanatomical targets to modulate pathological circuits in the brain. Traditionally, DBS is performed while the patient is awake to use micro-electrode recording and/or intraoperative test stimulation to help ensure optimal targeting of deep brain nuclei; however, recent advances in imaging technology have reduced this need. The objective of this case series is to compare the coordinates used in DBS procedures between awake and asleep patients.

Methods: Data was retrospectively collected from 38 DBS surgeries at the authors’ home institution between 2014 and 2022 that targeted the globus pallidus internus (GPi), subthalamic nucleus (STN), or ventral intermediate nucleus (VIM). The data was analyzed using SPSS Statistics software (version 29.0.2.0), using the chi-square and t tests as indicated.

Results: Of the 38 included procedures, 28 occurred while the patient was awake and 10 while the patient was asleep. Patients treated awake tended to be older than those treated asleep and have symptoms for longer prior to treatment (p <.05). The awake group had a higher percentage of male patients. The GPi and STN were each targeted in 10 procedures, and VIM was targeted 18 times with largely similar coordinates. Of note, the left-sided VIM coordinates were noted to be more lateral when performed awake versus asleep (p <.05).

Conclusion : At our institution, patients who underwent awake DBS were older, more likely to be male, and had symptoms longer than those who underwent surgery asleep. However, targets were largely similar between the two groups. Only a significant difference was seen in left-sided X coordinates between awake and asleep patients undergoing VIM DBS. Further studies will include larger patient groups and focus on clinical outcomes as they compare between the two groups.