Clinical Outcomes in Parkinson's Disease for Asleep Deep Brain Stimulation with Electrodes Placed using Intraoperative Imaging versus Awake Deep Brain Stimulation with Microelectrode Recording

Objective: To compare the difference in deep brain stimulation (DBS) surgery outcomes for Parkinson’s disease (PD) comparing targeting via intraoperative computed tomography imaging (ICT) to microelectrode recording (MER).Background: MER has been the gold standard for DBS targeting, however it requires more brain penetrations, patients are awake, and operative time is longer. ICT targeting allows equal accuracy of placement, is appealing to patients since performed under anesthesia, and may result in lower morbidity.Methods: PD Patients with motor complications referred for DBS were prospectively enrolled and underwent STN or GPi implantation using ICT. A historical PD cohort underwent GPi or STN DBS by the same surgeon using MER. Programming optimization was performed at 1,2,3 and 6 months post-implant. Unified PD Rating Scale (UPDRS), motor diaries, cognitive assessments, and the PD Questionnaire (PDQ-39) were performed at baseline and 6 months.Results: 30 subjects underwent ICT-guided DBS (9 STN and 21 GPi, mean age=61.1) and 34 subjects underwent MER-guided DBS (15 STN and 19 GPi, mean age=62.7). Mean 6-month improvement in OFF medication/ON DBS motor UPDRS was not significantly different between the ICT [14.3 (10.88)] and MER groups [17.6(12.26),t=1.15, p=0.25] Patients in the ICT group significantly improved on the PDQ-39 (+9.6,p= 0.005), mean ADL UPDRS (-5.6,p=.01), and ON time without dyskinesia (+4 hours/day,p=.04), all not significantly different from improvements in the MER group. Improvement in phonemic (+9.6) and semantic fluency (+7.9) were superior to changes in the MER group. There were no serious adverse events in the ICT DBS cohort.Conclusion: Motor and quality-of-life outcomes for asleep DBS using ICT and awake DBS using MER were equivalent. ICT DBS speech fluency outcomes were superior compared to MER. Asleep DBS was well tolerated with no complications, and should be an option that is offered to PD patients who are candidates for this therapy. Disclosure: Dr. Brodsky has received research support from Ipsen and Merz. Dr. Anderson has nothing to disclose. Dr. Seier has nothing to disclose. Dr. Wilhelm has nothing to disclose. Dr. Leelaamornvichet has nothing to disclose. Dr. Vederman has nothing to disclose. Dr. Burchiel has nothing to disclose.