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The effect of [[anesthesia]] type in terms of [[asleep]] vs. [[awake]] [[deep brain stimulation]] ([[DBS]]) surgery on [[therapeutic window]] (TW) has not been investigated so far. The objective of a study of Senemmar et al. was to investigate whether asleep [[DBS]] surgery of the [[subthalamic nucleus]] ([[STN]]) improves TW for both [[directional]] (dDBS) and [[omnidirectional]] (oDBS) stimulation in a large single-center population.

A total of 104 consecutive patients with [[Parkinson's disease]] (PD) undergoing STN-DBS surgery (80 asleep and 24 awake) were compared regarding TW, therapeutic [[threshold]], [[side effect]] threshold, [[improvement]] of Unified PD Rating Scale motor score ([[UPDRS]]-III) and degree of levodopa equivalent daily dose (LEDD) reduction.

Asleep DBS surgery led to significantly wider TW compared to [[awake surgery]] for both dDBS and oDBS. However, dDBS further increased TW compared to oDBS in the asleep group only and not in the awake group. Clinical efficacy in terms of UPDRS-III improvement and LEDD reduction did not differ between groups.

The [[study]] provides first [[evidence]] for improvement of therapeutic window by [[asleep surgery]] compared to [[awake surgery]], which can be strengthened further by dDBS. These results support the notion of preferring asleep over awake surgery but needs to be confirmed by [[prospective]] [[trial]]s
((Senemmar F, Hartmann CJ, Slotty PJ, Vesper J, Schnitzler A, Groiss SJ. Asleep Surgery May Improve the Therapeutic Window for Deep Brain Stimulation of the Subthalamic Nucleus [published online ahead of print, 2020 Jul 13]. Neuromodulation. 2020;10.1111/ner.13237. doi:10.1111/ner.13237)).