What is the difference between awake and asleep Deep Brain Stimulation surgery?

During “asleep” DBS surgery, general anesthesia is used and you are asleep through your surgery. You may find this more comforting. Intraoperative imaging provides accurate photos that allow the neurosurgeon to target the brain, without the need for your feedback. Parkinson’s patients can take their medicine on the day of their surgery.

During “awake” DBS surgery, you are kept alert during the operation. You may find this discomforting. The neurosurgeon uses cellular recordings to map the cells in the target region of your brain and relies on your feedback to determine accurate placement of the DBS electrodes. Parkinson’s patients cannot take their medicine.


DBS has dramatically changed the lives of many patients with uncontrollable tremors. Patients often can resume normal activities, such as feeding and dressing themselves, and can have active and fulfilling lives. The need for anti-tremor medications is often reduced or eliminated.

The future: DBS is reversible and adjustable

DBS blocks electrical signals from targeted brain areas. Thus, if newer, more promising treatments develop in the future, the DBS procedure can be reversed. The IPG is easily adjustable, without further surgery, if an individual patient’s condition changes.

Benefits of DBS:

  • DBS surgery can be performed on both sides of the brain
  • DBS surgery effects are reversible thus patients have the option of other treatments such as stem cell or gene therapy when they become available
  • IPG adjustments can be made to meet individual needs to minimize any side effects and improve efficacy
  • 24 hour symptom control

What are the risks?

In carefully selected and screened patients, DBS is quite safe and effective, but as with any surgery, there are some risks.  There is an estimated 2-3 percent risk of brain hemorrhage; there is a small risk of leakage of cerebrospinal fluid, which can lead to headaches or meningitis. There is a risk of infection, erosion, lead fractures, hardware breakage and IPG failure.

Relevant publications

  • Burchiel KJ, McCartney S, Lee A, Raslan A: Accuracy of deep brain stimulation electrode placement using intraoperative computed tomography without microelectrode recording. Journal of Neursosurgery, 2013, in press
  • Anderson VC, Burchiel KJ, Hart MJ, Berk C, Lou J-S (2009) A randomized comparison of thalamic stimulation and lesion on self-paced finger movement in essential tremor. Neuroscience Letters 462: 166-170
  • Shi Y, Burchiel KJ, Anderson VC, Martin WH (2009) Deep brain stimulation effects in patients with tinnitus. Otolaryngology - Head and Neck Surgery 141: 285-287
  • Zacest A, Burchiel KJ (2008) Deep Brain Stimulation for Non Movement Disorders. Contemporary Neurosurgery 30: 1-5
  • Eller JL, Burchiel KJ (2008) Deep Brain Stimulation for Tremor. In: Bakay R (ed) Movement Disorder Surgery: The Essentials. Thieme, pp 153-163
  • Burchiel KJ (2007) Optimal site in the subthalamic nucleus for deep brain stimulation.[comment]. Journal of Neurosurgery 106: 99-100
  • Kim MS, Jung YT, Sim JH, Kim SJ, Kim JW, Burchiel KJ (2006) Microelectrode recording: lead point in STN-DBS surgery. In: Chang JW, Katayama Y, Yamamoto T (eds) Acta Neurochirurgica Supplementum: Advances in Functional and Reparative Neurosurgery, vol 99. Springer, New York, pp 37-42
  • Raslan AM (2006) Deep brain stimulation for chronic pain: can it help? Pain 120: 1-2