Objective: To compare cognitive, psychiatric and quality of life (QoL) outcomes after awake and asleep bilateral pallidal (GPi) deep brain stimulation (DBS).

Background: Prior studies have shown motor outcomes using awake and asleep surgical methods to be comparable. Only one study (Brodsky et al. 2017) compared detailed neuropsychological (NP) outcomes in GPi and subthalamic (STN) DBS and found better verbal fluency outcomes after asleep surgery. No studies reported comparisons for GPi or STN individually.

Method: This is a retrospective comparison of persons with Parkinson’s disease who underwent awake or asleep bilateral GPi DBS. The awake (n=10) and asleep (n=20) groups were of similar age, education and disease duration. Comprehensive NP evaluations were generally carried out within 3 months before and within one year after surgery. Not all patients received every test due to time constraints or patient factors. NP variables were analyzed with mixed analysis of variance using within (pre, post) and between (awake, asleep)  factors.

Results: A significant interaction term (p<.02) disclosed a decline in category fluency in the awake but not asleep group. A main effect of time (p<.04) revealed a decline in phonemic fluency after DBS, but the interaction was not significant. Similarly, tasks demanding of visual perceptual gestalt formation (p<.03) and response initiation (p=.01) disclosed post DBS declines but the interactions were not significant. A significant interaction on a conceptualization task (p<.05) indicated improvement on a conceptualization task in only the awake group. There was a diminished perseverative tendency post-DBS. The QUIP-RS revealed greater post-surgical impulsivity as regards gambling, shopping, and hobbyism in the awake group. Emotion and QoL outcomes were comparable in the two groups.

Conclusion: Few cognitive declines were observed. Verbal fluency declines after DBS but, like Brodsky et al., we observed better fluency outcomes in the asleep group. Microelectrode tracts during awake surgery may impact category fluency. Post-surgical impulsivity may increase less after asleep surgery. QoL outcomes were comparable. The two surgical methods have more similar than dissimilar neuropsychological and quality of life outcomes.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neuropsychological-and-quality-of-life-outcome-comparison-after-awake-and-asleep-pallidal-deep-brain-stimulation-dbs-surgery-for-parkinsons-disease/