The greatest benefit of asleep deep brain stimulation is that the patient can remain sedated while the surgery is being performed. This is of great comfort to many patients. Asleep DBS, performed at the Denver DBS Center, also has many clinical benefits. Asleep deep brain stimulation (DBS) has turned the traditional three-step process into two, while shortening surgery time and improving placement of the electrode. In addition, electrode placement during Asleep DBS takes roughly half the time as Awake DBS. The Denver DBS Center also is able to achieve more accurate placement of the electrodes, resulting in improved outcomes over traditional deep brain stimulation performed while patients are awake.
Highlights of Asleep DBS include:
- Only entails two surgeries rather than four required for bilateral electrodes and generators placed during traditional (awake) deep brain stimulation
- Shorter surgery time; 2-3 hours compared to 4-6 hours for Awake DBS
- More precise electrode placement: within 1 millimeter of the target compared with 1-2 millimeters with traditional DBS
- Less variation in cost than awake DBS
Denver DBS Center’s David VanSickle, MD, PhD, has advanced an evidence-proven Asleep DBS procedure and is one of only a few neurosurgeons worldwide to offer Asleep DBS. First offered by Denver DBS Center in early 2013, Asleep DBS is now the procedure of choice for 60-70% of Denver DBS Center patients.
A study published in the Journal of Neurosurgery evaluating DBS in patients under general anesthesia (asleep) using the traditional procedure found it as safe and effective as the procedure performed under local anesthesia (awake). Our team at the Denver DBS Center conducted a study of robot assisted asleep deep brain stimulation in 125 patients and found a 25% improvement in the accuracy of electrode placement and shorter surgical times. The study was published in the Annals of Biomedical Engineering.
FAQs About Asleep DBS
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ArticlesWhat are the deep brain stimulation benefits?
While not a cure for movement disorders, there are many deep brain stimulation benefits. Deep brain stimulation surgery can reduce many of the side effects associated with movement disorders, including Parkinson’s disease, essential tremor, epilepsy, and dystonia including:
- Tremors
- Rigidity
- Stiffness
- Slow Movements
- Walking Problems
Research has shown that DBS reduces medication use, improves quality of life, and extends life for Parkinson’s patients.
What is asleep deep brain stimulation?
Asleep deep brain stimulation (DBS) is a neurological procedure used to treat movement disorders like Parkinson’s disease, epilepsy, dystonia, and essential tremor. Unlike the traditional DBS procedure, which requires 3 surgeries, two of which are performed awake, Asleep DBS only entails two surgeries. The initial surgery allows for lead planning and placement under general anesthesia (asleep) by utilizing a portable CT machine (CereTom®) to provide intraoperative images that can be overlaid on an earlier MRI. The second surgery entails the implantation of the generator.
What is Asleep DBS with robotics guidance?
Robotics guidance provides improved accuracy of the DBS lead placement, the most important aspect of DBS. The more accurate the lead placement, the better control over symptoms of movement disorders, like Parkinson’s disease.
Denver DBS Center board-certified neurosurgeon David VanSickle, MD, PhD, was the first in the world to perform Asleep DBS utilizing the Mazor Robotics Renaissance Guidance System. The system is a state-of-the-art surgical guidance system that enables surgeons to conduct spine and brain procedures in an accurate and secure manner.
When should I consider Asleep DBS?
Asleep DBS is the procedure of choice for most patients. For the small percentage of patients who cannot undergo Asleep DBS, Awake DBS may still be an option.
New research shows that undergoing DBS in the earlier stages of Parkinson’s disease is effective, contrary to earlier recommendations that patients must have the disease for at least seven years to benefit. The study also found DBS to be more effective than medications in controlling tremors in patients with Parkinson’s disease.
Is Asleep DBS as safe and effective as traditional DBS?
Numerous studies have shown that Asleep DBS is as safe and effective as traditional (awake) DBS. In fact, Asleep DBS has been shown to lead to better electrode placement and patient outcomes.
Learn more about specific outcomes based on your movement disorder:
- Research in the Journal of Neurosurgery shows significantly improved outcomes for patients undergoing Asleep DBS with lead placement guided by computed tomography (CT).
- Research published in the Journal of Neurosurgery shows that initial results of asleep ventral intermediate nucleus (VIM) DBS for essential tremor deem the procedure as safe and effective as the traditional awake DBS procedure for essential tremor. The study also shows lead placement errors to be slightly less in asleep DBS than awake DBS. Additional studies are underway to build upon these findings.
What are the advantages of Asleep DBS over Awake DBS?
Asleep DBS entails fewer surgeries, shorter procedure times, and improved electrode placement.
- Entails two surgeries, both of which are performed with the patient asleep.
- Entire procedure takes 2-3 hours; electrode placement is typically within 1 millimeter of target.
- Electrode testing not necessary.
Awake DBS:
- Requires four surgeries (for bilateral placement), two of which are performed while the patient is awake.
- Electrode placement takes 4-6 hours; placement is within 1-2 millimeters of target.
- Electrode testing conducted during surgery to ensure proper placement.
A research study written by Denver DBS Center founder, David VanSickle, MD, PhD, highlights the observable and unobservable errors present in traditional microelectrode recording (MER) (Awake DBS surgery) compared to Mazor Renaissance Guidance System with CereTom CT image verification (Asleep DBS).
Additional studies show improved outcomes with Asleep DBS, potential inaccuracies with MER (traditional) DBS, and improved electrode accuracy with Asleep DBS.
