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Awake deep brain stimulation (DBS) surgery can provide information beyond what imaging alone can capture, helping clinicians personalize electrode placement for patients with essential tremor, according to a Mayo Clinic study published in Operative Neurosurgery.

DBS surgery involves implanting thin wires with electrodes, known as leads, into specific areas of the brain. The electrodes deliver electrical impulses that affect brain activity and can be used to treat brain disorders such as essential tremor, Parkinson's disease and dystonia. Imaging helps clinicians plan where to place the leads.

"In many patients, following a standard target based on imaging can lead to optimal therapy. But sometimes the best lead location for a patient may be in a slightly different position," says Bryan Klassen, M.D., a Mayo Clinic neurologist and study co-author.

During awake DBS surgery, neurosurgeons and neurologists can measure brain activity, test stimulation and receive feedback from the patient. This information can help the surgical team adjust lead placements during the procedure.

"It is an interactive process that gives us the ability to evaluate patient responses during the procedure and immediately adjust lead placement if neurophysiological recordings or stimulation testing reveal suboptimal positioning," says Matthew R. Baker, Ph.D., a neurosurgery scientist at Mayo Clinic and study co-author. In contrast, DBS performed while the patient is asleep relies primarily on imaging to guide lead placement.

In the retrospective study, Mayo Clinic researchers examined 137 DBS leads implanted in patients who were awake during surgery for essential tremor .

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