Awake versus asleep deep brain stimulation for Parkinson's disease: a comprehensive systematic review and meta-analysis

Authors

Seyed Farzad Maroufi, Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
Mohammad Sadegh Fallahi, Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
Saba Hosseinzadeh Asli, Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
MirHojjat Khorasanizadeh, Department of Neurosurgery, Mount Sinai Hospital, Icahn School of Medicine, New York, New York.
Ahmad Pour-Rashidi, Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran.
Francisco A. Ponce, Barrow Center for Neuromodulation, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and.
Konstantin V. Slavin, Department of Neurosurgery, University of Illinois at Chicago, Illinois.

Document Type

Article

Abstract

OBJECTIVE: Deep brain stimulation (DBS) has become an effective and safe treatment in patients with Parkinson's disease (PD) not responding to conventional treatments. With the growing body of literature regarding the use of DBS in different movement disorders, there remain controversies regarding performing awake or asleep DBS. This systematic review provides the most comprehensive review of the literature comparing the two techniques from various aspects in detail. METHODS: A systematic review of the PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted. All studies comparing any aspects of asleep and awake DBS were included. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions tool. Meta-analysis was conducted with consideration of baseline characteristics. RESULTS: Thirty-one studies with 2563 PD patients were included. A total of 1423 patients underwent asleep DBS. The two groups were comparable regarding their baseline characteristics. The follow-up ranged from 3 to 60 months. The two DBS techniques were comparable in terms of motor symptom improvements and levodopa equivalent daily doses. However, the asleep technique showed slightly better improvements in Mattis Dementia Rating Scale and Parkinson's Disease Questionnaire scores. Moreover, the asleep technique was associated with more surgical adverse events, whereas pneumocephalus and psychological disorders such as mood, affect, and cognitive disorders were more common in the awake technique. Subgroup analyses revealed no significant differences in outcomes between asleep and awake DBS when categorized by targeted brain nuclei, use of intraoperative or preoperative imaging, and whether microelectrode recordings were used. CONCLUSIONS: These findings suggest comparable clinical outcomes between the two DBS approaches. The two methods had their salient differences in terms of lead passes and specific adverse events. The decision to perform awake or asleep DBS should be based on the patient's preference, the surgeon's experience, the availability of advanced intraoperative imaging, and the patient's tolerance for specific adverse events.

Medical Subject Headings

Humans; Deep Brain Stimulation (methods); Parkinson Disease (therapy); Wakefulness (physiology); Treatment Outcome

Publication Date

2-1-2025

Publication Title

Journal of neurosurgery

E-ISSN

1933-0693

Volume

142

Issue

2

First Page

324

Last Page

338

PubMed ID

39151185

Digital Object Identifier (DOI)

10.3171/2024.4.JNS232553

Recommended Citation

Maroufi, Seyed Farzad; Fallahi, Mohammad Sadegh; Hosseinzadeh Asli, Saba; Khorasanizadeh, MirHojjat; Pour-Rashidi, Ahmad; Ponce, Francisco A.; and Slavin, Konstantin V., "Awake versus asleep deep brain stimulation for Parkinson's disease: a comprehensive systematic review and meta-analysis" (2025). Neurosurgery. 2244.
https://scholar.barrowneuro.org/neurosurgery/2244