Objective: To compare trends and perceptions regarding Asleep and Awake deep brain stimulation (DBS) in North America (NA) and Europe (EU).

Background: DBS clinical practice continues to evolve. Trends and perceptions regarding optimal workflow may vary between DBS clinicians in NA and EU.

Method: A panel of DBS clinicians created a REDCap survey regarding DBS practice in the US and abroad. It was sent to DBS clinicians of the Parkinson Study Group, DBS Think Tank, World Society for Stereotactic and Functional Neurosurgery, and Movement Disorder Society.

Results: There were 214 respondents from NA (53% neurosurgeons, 43% Neurologists and 4% APP) and 61 from EU (69% neurosurgeons, 30% neurologists and 1% APP). In NA, 54% perform both asleep and awake, 28% awake only, and 18% asleep only. In EU, 66% perform both asleep and awake, 18% awake only, and 16% asleep only. In NA, of 60 centers performing both awake and asleep DBS, 75% choose awake for STN, 45% choose awake for GPI, 90% choose awake for VIM. In EU, out of 33 centers performing both, 30% choose awake for STN, 0% choose awake for GPI and 80% choose awake for VIM. For asleep surgery, NA centers offer i-MRI in 37%, vs EU centers 0%. In NA, microelectrode recording (MER) is used during asleep DBS in 27% vs in EU 69% of cases. Whether awake or asleep, single channel MER is most common in NA vs 2-3 or 4-5 channels in EU. When asked to agree or disagree with: “asleep DBS is equal to or more effective than awake DBS” for each target, the NA group agreed/disagreed as follows: STN: 28%/43%; GPI: 53%/29%; VIM: 13%/64% vs the EU group: STN: 53%/35%; GPI: 73%/15%; VIM: 15%/56% (remainder: ‘similar’ or ‘no experience’). When presented with 8 techniques for awake/asleep DBS, the choice for the ‘Most optimal technique for each target’, was ‘awake+MER+test stimulation for STN and VIM (not GPI) in NA and EU. Similarly, when choosing the ‘least optimal technique for each target’, NA and EU agreed on ‘asleep iCT/Oarm’ for STN, GPI and VIM.

Conclusion: Both continents revealed a preference for Awake DBS for VIM and STN, and Asleep DBS for GPI. ‘The most optimal technique’ in NA and EU was ‘awake+MER+stim’ for STN and VIM, and ‘asleep iMRI’ for GPI. ‘The least optimal technique’ for all 3 targets was ‘asleep iCT/Oarm’ (without physiology) in both continents. In EU, but not NA, asleep DBS was performed with MER in majority of the cases.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-trends-in-asleep-and-awake-dbs-in-north-america-vs-europe/