Wang Xin, Tian Lu
Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China.
Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
J Neurol. 2025 Jul 21;272(8):525. doi: 10.1007/s00415-025-13264-0.
There remains controversies regarding the selection of anesthesia method in the procedure of deep brain stimulation (DBS) for Parkinson disease (PD). This study was to compare the efficacy and safety between asleep (general anesthesia) and awake DBS (local anesthesia) from various aspects.
A comprehensive literature retrieval until April 2025 was conducted based on four electronic databases. We included studies involving comparisons of asleep and awake DBS and reporting outcomes at ≥ 3 months follow-up visit. Motor and various non-motor outcomes were compared between the two groups. Subgroup analysis was also conducted to identify the potential influential factors of the outcomes.
Twenty-seven articles involving 28 trials were included. On the whole, there were no significant between-group differences regarding the relative changes in UPDRS-III scores, LEDD, depression, cognition, and quality of life. The rates of adverse events, including intracranial hemorrhage, infection, and stimulation-related complications were also comparable between these two groups. Subgroup analyses indicated no significant between-group differences when categorized by DBS targets, intraoperative imaging guidance, and use of microelectrode recordings (MER) in the surgical procedure. In particular, asleep DBS with intraoperative imaging was comparable to awake DBS in improving motor outcomes.
On the whole, the efficacy, and safety outcomes were comparable between awake DBS and asleep DBS for PD. Therefore, asleep DBS may be an alternative therapeutic method to awake DBS. Additionally, intraoperative imaging guidance was recommended in the procedure of asleep DBS. Further prospective studies are needed before the establishment of a more compelling conclusion.
在帕金森病（PD）的脑深部电刺激（DBS）手术中，麻醉方法的选择仍存在争议。本研究旨在从多个方面比较睡眠状态（全身麻醉）和清醒状态下DBS（局部麻醉）的疗效和安全性。
基于四个电子数据库进行全面的文献检索，直至2025年4月。我们纳入了涉及睡眠状态和清醒状态下DBS比较且报告随访≥3个月结果的研究。比较两组之间的运动和各种非运动结果。还进行了亚组分析以确定结果的潜在影响因素。
纳入了27篇文章，涉及28项试验。总体而言，两组在帕金森病统一评分量表第三部分（UPDRS-III）评分、左旋多巴等效剂量（LEDD）、抑郁、认知和生活质量的相对变化方面没有显著差异。两组之间包括颅内出血、感染和刺激相关并发症在内的不良事件发生率也相当。亚组分析表明，按DBS靶点、术中成像引导和手术中使用微电极记录（MER）分类时，两组之间没有显著差异。特别是，术中成像的睡眠状态下DBS在改善运动结果方面与清醒状态下DBS相当。
总体而言，清醒状态下DBS和睡眠状态下DBS治疗PD的疗效和安全性结果相当。因此，睡眠状态下DBS可能是清醒状态下DBS的一种替代治疗方法。此外，建议在睡眠状态下DBS手术中采用术中成像引导。在得出更有说服力的结论之前，还需要进一步的前瞻性研究。
