OHSU study validates deep brain surgery while asleep for Parkinson's patients

By Elizabeth Hayes  –  Staff Reporter, Portland Business Journal

Nov 3, 2017, 4:12pm

Most brain surgeons in the U.S. perform the procedure with patients awake the whole time. Not at OHSU.Most surgeons perform deep brain stimulation to ease the effects of Parkinson’s disease while the patient is awake. Not at Oregon Health & Science University. OHSU neurologists stopped doing awake surgeries in January 2011. They pioneered a technique to accurately map the brain before and during the procedure, allowing the patient to remain asleep with general anesthesia all the while. With DBS, surgeons implant electrodes into specific areas of the brain that control movement in order to improve motor function and ease tremors, muscle rigidity and slowed movement. The procedure is usually done after a patient’s medications lose their efficacy. New research from OHSU found that clinical outcomes for the asleep version of the procedure measure up to the awake variety. A trial of 69 people who underwent deep brain stimulation, or DBS, surgery at OHSU showed no demonstrable difference in improvement in those areas between those who underwent asleep-DBS vs. awake-DBS. And those who were asleep experienced better outcomes in terms of communication, cognition and speech. Dr. Matthew Brodsky, an associate professor of neurology at OHSU and medical director of OHSU’s deep brain stimulation program, believes the cause may have to do with the fact that in the awake DBS, surgeons place multiple microelectrodes into brain tissue to identify the location and borders of the targeted region.

The patient answers questions to validate the effectiveness. The neurosurgeon has to send the probes into the brain twice, once to map and once to place the electrode that will be left in the brain. Asleep DBS requires just a single pass, with a pre-operative MRI and a CT scan during the procedure. Burchiel developed the technique to localize the electrodes and target and place them using imaging. “One theory as to why (speech) would worsen is that it’s related to a side effect of stimulation itself,” Brodsky said.

“But in patients where it wasn’t turned on, their speech fluency also worsened. So I thought maybe it was the way it was implanted.”

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