Is the Patient Awake During DBS Surgery?
In brief
A patient does not always have to remain awake during deep brain stimulation surgery. DBS lead placement can be performed while the patient is awake with local anaesthesia and light sedation, or while the patient is asleep under general anaesthesia.
The most appropriate approach depends on the patient, the surgical target, the technology available and the DBS team’s preferred method.
Why are some patients awake during DBS surgery?
During awake DBS, the scalp is numbed and medication may be given to help the patient relax. The patient can communicate with the surgical team during important parts of the procedure.
This allows the team to assess movement symptoms, speech and possible stimulation-related side effects while positioning the DBS lead. Brain signals may also be recorded to help confirm the intended target.
Being awake does not mean the patient is expected to tolerate uncontrolled pain. Comfort and anxiety are managed throughout the operation.
What happens during asleep DBS?
In asleep DBS, the patient is under general anaesthesia during lead placement. The surgeon uses detailed MRI or CT-based planning and, in some centres, intraoperative imaging to confirm the position of the electrodes.
Modern imaging and surgical technologies have made asleep DBS an established option in appropriately selected patients. Current patient guidance from the Parkinson’s Foundation confirms that DBS may be performed either awake or asleep, depending on the centre.
Is one method more successful than the other?
Neither method is automatically the best option for every patient.
Research comparing awake and asleep DBS has generally reported comparable motor outcomes in appropriately selected patients, although the techniques, targets and imaging systems differ between centres. The choice should therefore be individual rather than based on the assumption that one method is universally superior.
In my discussions with patients, I focus on why a particular technique is being recommended for them and how electrode placement will be verified during the procedure.
Who may prefer asleep DBS?
Asleep DBS may be considered for patients who:
Have significant anxiety about remaining awake
May have difficulty lying still for an extended period
Experience painful rigidity or severe tremor
Have medical or psychological factors that make awake surgery challenging
Are being treated at a centre with suitable intraoperative imaging technology
These factors do not automatically determine the technique. Anaesthesia safety, the selected brain target and the experience of the surgical team must also be considered.
What can the patient expect during awake DBS?
The exact process varies between centres, but the patient may be asked to:
Move an arm or leg
Open and close the hand
Speak or repeat words
Describe unusual sensations
Report changes in stiffness or tremor
These short tests help the team evaluate the effect of stimulation and identify unwanted effects before the final electrode position is confirmed.
You can also read How Is Deep Brain Stimulation Surgery Performed? for an overview of the full DBS procedure.
Is the battery also implanted while the patient is awake?
DBS surgery may be completed in one operation or divided into stages.
Even when the brain electrodes are placed while the patient is awake, implantation of the pulse generator—usually positioned beneath the skin of the upper chest—is commonly performed under general anaesthesia. The exact sequence varies between surgical teams.
Questions to ask your DBS team
Before surgery, patients may wish to ask:
Will my electrode placement be awake or asleep?
How will the target position be confirmed?
Will microelectrode recording be used?
What type of anaesthesia or sedation will I receive?
Will the lead and pulse generator be implanted on the same day?
When will DBS programming begin?
A clear preoperative explanation can make the process considerably less stressful.
Frequently asked questions
Will I feel the brain electrode being inserted?
The surgical team uses local anaesthesia for pain-sensitive tissues such as the scalp. Patients may notice pressure, sounds or activity around them, but pain and anxiety should be discussed immediately with the anaesthesia team.
Can I change my mind if I am afraid of awake surgery?
Concerns should be discussed during the preoperative assessment. Whether asleep DBS is suitable depends on the centre’s technique, the available imaging and the individual clinical situation.
Does being asleep make electrode placement less accurate?
Not necessarily. Asleep DBS uses image-guided methods to plan and verify electrode placement. Accuracy depends on the complete surgical workflow and the experience of the team, rather than anaesthesia alone.
Is awake DBS safe?
Awake DBS is a well-established approach. However, both awake and asleep procedures involve the general risks of DBS surgery and require an experienced multidisciplinary team.
Conclusion
Some patients are awake during DBS lead placement, while others remain asleep under general anaesthesia. Both approaches can be appropriate.
The important question is not simply whether the patient will be awake, but how the surgical target will be identified, how electrode placement will be verified and which approach best fits the individual patient.
Dr Kaan Tuğberk ÖzdemirNeurosurgeon – İzmir, Türkiye
This article provides general medical information and does not replace an individual consultation or medical assessment.
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