Category: Surgical Therapy: Parkinson's Disease
Objective: To compare trends and perceptions regarding Asleep and Awake deep brain stimulation (DBS) between neurologists (NLGs) and neurosurgeons (NSXs) in the USA and abroad.
Background: DBS is a multidisciplinary treatment with NSXs performing the procedure and NLGs optimizing clinical outcome. Whether their respective viewpoints regarding asleep and awake DBS procedures converge is of potential interest but has not been studied.
Method: A panel of DBS clinicians created a REDCap survey regarding DBS practice in the US and abroad. The survey was sent out to the Functional Neurosurgery Working Group of the Parkinson Study Group, DBS Think Tank, World Society for Stereotactic and Functional Neurosurgery, and Movement Disorder Society members with stated DBS interest.
Results: Of 321 individual respondents from 38 countries and 6 continents 60% were NSXs, 37% NLGs, and 3% Advanced Practice Providers. Fifty-eight percent perform both awake and asleep DBS procedures, 26.8% awake only, and 15.5% asleep only. Focusing only on 117 respondents who offer both options, 70% choose awake for STN, 45% choose awake for GPI, 92% choose awake for VIM. When asked to agree or disagree with “asleep DBS is equal to or more effective than awake DBS” for each target, NLGs agreed/disagreed as follows: VIM: 11.8%/62.8%, STN: 26%/47%, GPI: 49%/31%, vs NSXs: VIM: 13.6%/58%, STN: 32.6%/37.1%, GPI: 64.1%/18% (remainder: ‘similar’ or ‘no experience’). When asked to choose the ‘most optimal technique’ out of 7 awake/asleep DBS techniques, both NLGs and NSXs selected ‘awake+microelectrode recording (MER)+test stimulation (stim)’ for STN and VIM. For GPI, NLGs preferred ‘awake+MER+stim’, while NSXs preferred ‘asleep interventional-MRI’ (iMRI). For ‘least optimal technique for each target’, NLGs and NSXs both chose ‘asleep iCT/Oarm’ for STN, GPI and VIM.
Conclusion: In this survey, NLGs and NSXs showed similar preferences for awake DBS when targeting VIM and STN, while for GPI the results were more variable. Compared to NLGs, NSXs had a more favorable opinion on asleep procedures, especially iMRI, while NLGs preferred physiological confirmation for all targets. These results provide only a snapshot of current DBS trends, and perceptions may change with future technological advances.
To cite this abstract in AMA style:
A. Tsai, B. Dalm, L. Almeida, S. de Jesus, A. Fasano, K. Foote, Y. Gordeyeva, J. Jimenez-Shahed, D. Pathadan, N. Pouratian, J. Rolston, J. Rosenow, D. Safarpour, J. Schwalb, M. Siddiqui, M. Spindler, J. Wong, L. Verhagen Metman. Perceptions Regarding Asleep and Awake DBS Among Neurologists and Neurosurgeons [abstract]. Mov Disord. 2024; 39 (suppl 1). https://www.mdsabstracts.org/abstract/perceptions-regarding-asleep-and-awake-dbs-among-neurologists-and-neurosurgeons/. Accessed October 7, 2024.« Back to 2024 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/perceptions-regarding-asleep-and-awake-dbs-among-neurologists-and-neurosurgeons/