Advances in high resolution intra-operative imaging technologies have allowed for the successful implantation of DBS electrodes in subcortical targets under general anesthesia (“asleep” surgery) in contrast to traditional microelectrode recording based targeting under light anesthesia (“awake” surgery). Both techniques have shown similar outcomes in both lead placement and early clinical response. Longer term studies comparing functional outcomes between asleep vs awake STN DBS in PD patients are lacking.

We retrospectively reviewed quality of life and functional outcomes in PD patients who underwent either asleep or awake STN DBS by a single surgeon at our center. We assessed changes in quality of life through phone surveys using a modified Euro-QoL-5D-5L. We performed a retrospective chart review comparing objective clinical metrics including levodopa equivalent dose changes and complexity of DBS programming between the two surgical techniques. We compared clinical metrics at time points of 6, 12, and 24 months post-implantation.

We found no significant differences in patient-reported quality of life metrics between awake and asleep surgical techniques; all patients reported overall improvement in domains including mobility, ability to perform activities of daily living, pain, and mood. Patients who underwent asleep technique reported a better surgical experience and fewer bothersome side effects from DBS, though all patients would choose to undergo DBS surgery again. Changes in clinical metrics pre- and post-DBS implantation were similar between asleep vs awake cohorts.

Our results demonstrate similar retrospective outcomes between asleep and awake STN DBS in PD patients across patient-reported functional outcomes and clinical metrics.