{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:36:35Z","timestamp":1789605395350,"version":"build-2803163510"},"reference-count":59,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Deep brain stimulation (DBS) has become an effective and safe treatment in patients with Parkinson\u2019s disease (PD) not responding to conventional treatments. With the growing body of literature regarding the use of DBS in different movement disorders, there remain controversies regarding performing awake or asleep DBS. This systematic review provides the most comprehensive review of the literature comparing the two techniques from various aspects in detail.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A systematic review of the PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted. All studies comparing any aspects of asleep and awake DBS were included. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions tool. Meta-analysis was conducted with consideration of baseline characteristics.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Thirty-one studies with 2563 PD patients were included. A total of 1423 patients underwent asleep DBS. The two groups were comparable regarding their baseline characteristics. The follow-up ranged from 3 to 60 months. The two DBS techniques were comparable in terms of motor symptom improvements and levodopa equivalent daily doses. However, the asleep technique showed slightly better improvements in Mattis Dementia Rating Scale and Parkinson\u2019s Disease Questionnaire scores. Moreover, the asleep technique was associated with more surgical adverse events, whereas pneumocephalus and psychological disorders such as mood, affect, and cognitive disorders were more common in the awake technique. Subgroup analyses revealed no significant differences in outcomes between asleep and awake DBS when categorized by targeted brain nuclei, use of intraoperative or preoperative imaging, and whether microelectrode recordings were used.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>These findings suggest comparable clinical outcomes between the two DBS approaches. The two methods had their salient differences in terms of lead passes and specific adverse events. The decision to perform awake or asleep DBS should be based on the patient\u2019s preference, the surgeon\u2019s experience, the availability of advanced intraoperative imaging, and the patient\u2019s tolerance for specific adverse events.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.4.jns232553","type":"journal-article","created":{"date-parts":[[2024,8,17]],"date-time":"2024-08-17T01:27:36Z","timestamp":1723858056000},"page":"1-15","source":"Crossref","is-referenced-by-count":11,"title":["Awake versus asleep deep brain stimulation for Parkinson\u2019s disease: a comprehensive systematic review and meta-analysis"],"prefix":"10.3171","author":[{"given":"Seyed Farzad","family":"Maroufi","sequence":"first","affiliation":[{"name":"Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran;"},{"name":"Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Sadegh","family":"Fallahi","sequence":"additional","affiliation":[{"name":"Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran;"},{"name":"Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saba","family":"Hosseinzadeh Asli","sequence":"additional","affiliation":[{"name":"Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran;"},{"name":"Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MirHojjat","family":"Khorasanizadeh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mount Sinai Hospital, Icahn School of Medicine, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Pour-Rashidi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco A.","family":"Ponce","sequence":"additional","affiliation":[{"name":"Barrow Center for Neuromodulation, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantin V.","family":"Slavin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Illinois at Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Neurodegener Dis Manag","first-page":"299","article-title":"Deep brain stimulation for Parkinson\u2019s disease: current status and future outlook","volume":"6","author":"Smith KA","year":"2016","unstructured":"Smith KA, Pahwa R, Lyons KE, Nazzaro JM. 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