If you’re curious about deep brain stimulation (DBS), you’re not alone. It’s one of the most promising Parkinson’s disease treatments out there for patients whose symptoms can’t be controlled with medications. Here at Neurology Solutions Movement Disorders Center, we implant DBS leads in very specific parts of the brain — accurate to under a millimeter — that can provide stimulation and help reduce the effects of Parkinson’s disease.
If you’ve heard about DBS as a Parkinson’s treatment, you’ve probably run across the fact that there are two ways to undergo the procedure: awake and asleep. There is debate going on in the neurology world as to whether awake DBS or asleep DBS is more effective for patients. At Neurology Solutions, we prefer to have the patient awake during the procedure if at all possible. While this might make some patients squeamish, there are some very good reasons we’ll detail below.
The differences between asleep and awake DBS has come to a head in Texas, as some hospitals have begun to offer asleep DBS exclusively, meaning that they are not equipped to do awake DBS. While we understand the interest patients have in asleep DBS, the professional opinion of the neurologist at our movement disorders clinic is that asleep DBS is being oversold. Here’s why.
Asleep DBS Without Testing Is Not FDA Approved
When a doctor prescribes a medication for a patient for a condition other than what the medication is officially approved for, this is called an “off-label” prescription. This means that the medical community believes the drug to be effective, though it is not officially approved by the FDA to treat a condition.
Any time asleep DBS is performed without testing the patient for lead placement benefit versus side effects, it is effectively being performed “off-label.” It is not FDA approved, while awake DBS is approved as a Parkinson disease treatment. The studies have been performed to show the efficacy of awake DBS, but asleep DBS is still in the experimental phase. Third-party tests still need to be performed to compare the two, ones that are free from bias.
Asleep DBS Is Biased
Speaking of bias, it’s important to know that there’s a financial incentive for those who are performing asleep deep brain stimulation. Some patients avoid awake DBS because they fear having the procedure performed while they are awake (see below). This means there’s an incentive for hospitals and the manufacturers of DBS equipment to push the idea of asleep DBS in order to capture this market. No doubt the hope is also to sway people who are on the fence to the asleep DBS side.
Asleep DBS Doesn’t Allow For Patient Response
The primary reason that patients seem to prefer asleep DBS implantation is that they are unconscious for the procedure. This is understandable, though it’s important to note that the brain can feel no pain when directly stimulated. While local anesthetics are used to reduce and often eliminate pain from during awake DBS surgery, the idea of being awake while a neurosurgeon places the DBS leads in the brain can be an unsettling idea.
But we think it vital that patients are awake for certain parts of the procedure, and we can provide adequate medication to help reduce anxiety and even sedate partially during the more stressful parts of the procedure. When a patient is awake, they are able to let the surgeon know how the deep brain stimulation is working in real time. Speech, dexterity, coordination, vision, mood, and heat intolerance can all be addressed immediately, and the electrical leads can be moved accordingly.
Asleep DBS without thorough testing doesn’t offer these advantages. When a patient is asleep, neither they nor the surgeon have any way of knowing if the brain stimulator is working until the patient is awake. If the stimulator is just a millimeter off, optimal benefit from stimulation will not be achieved.
Talk With Neurology Solutions About DBS
Having performed over 300 DBS procedures in Austin, we are convinced that awake implantation is the only way to confirm the proper lead placement for achieving the best efficacy, all while introducing the least risk of side effects. We hope you’ll contact us with any questions you have, and we can walk you through the procedure to show you the many advantages awake DBS provides.