Asleep Deep Brain Stimulation Linked to Better Outcomes in Parkinson's
Deep brain stimulation is indicated for patients with advanced disease who are refractory to treatment.
Asleep deep brain stimulation (DBS) is superior to awake DBS for improving motor outcomes, speech fluency, and quality of life in people with Parkinson disease (PD) over a 6-month period, based on study findings published in the journal Neurology.
Investigators compared 6-month outcomes of patients with PD who underwent asleep DBS (n=30) or awake DBS (n=39). Patients underwent DBS at the same center and under the guidance of the same surgeon. Researchers used the OFF-levodopa Unified Parkinson's Disease Rating Scale (UPDRS) II and III as well as the 39-item Parkinson's Disease Questionnaire to evaluate outcomes. Additionally, investigators evaluated motor diaries and patients' speech fluency following treatment.
The researchers observed no significant difference in the improvement of UPDRS II (+9.3±2.7 vs +7.4±5.8 points, P =.16) or III scores (+14.8±8.9 vs +17.6±12.3 points, P =.19). Overall, there were greater improvements in ON time without dyskinesia in asleep DBS vs awake DBS (+6.4±3.0 hours/day vs +1.7±1.2 hours/day, respectively; P =.002).
Participants undergoing asleep DBS also demonstrated more improvements in cognition (P =.011) and communication (P =.001). In addition, asleep DBS resulted in greater improvements in speech fluency (+1.0±8.2 points vs -5.5±9.6 points, P =.038). Both groups demonstrated improvements in quality of life (+18.8±9.4 in awake DBS vs +8.9±11.5 in asleep DBS).
According to the investigators, the costs related to DBS procedures represent a potential limiting factor in the access to therapy. The duration of the procedure as well as its associated neurologic assessments can increase care costs substantially, whereas reducing operative time may help optimize costs for patients.
Although cost implications may play a role in PD patient care, asleep DBS “allows for greater patient comfort, making this option more accessible for patients who otherwise might not choose it.”
Brodsky MA, Anderson S, Murchison C, et al. Clinical outcomes of asleep vs awake deep brain stimulation for Parkinson disease [published online October 6, 2017]. Neurology. doi:10.1212/WNL.0000000000004630