Clinical Outcomes of Robot-Assisted “Asleep” Deep Brain Stimulation With Microelectrode Recording in Parkinson’s Disease

Background: Deep brain stimulation (DBS) is a well-established treatment for movement disorders, particularly Parkinson’s disease (PD), where precise electrode placement is critical for optimal outcomes. With advances in robotic systems and imaging technologies, robot-assisted asleep DBS combined with microelectrode recording (MER) has emerged as a promising technique. This study aimed to evaluate the surgical accuracy and clinical outcomes of robot-assisted asleep DBS with MER in PD patients. Methods: We conducted a retrospective review of PD patients who underwent either robot-assisted asleep DBS or conventional manual frame-based DBS at a single center between August 2021 and August 2024. Targeting accuracy was assessed using radial error measured on intraoperative computed tomography. Clinical outcomes were evaluated using the Unified Parkinson’s Disease Rating Scale (UPDRS), levodopa equivalent daily dose (LEDD), and the Parkinson’s Disease Questionnaire-39 (PDQ-39) at baseline, 6 months, and 1 year postoperatively. Results: A total of 51 patients underwent robot-assisted asleep DBS. This group demonstrated significantly higher targeting accuracy than the manual frame-based group (P = 0.001). Both surgical methods resulted in significant improvements in UPDRS, LEDD, and PDQ-39 scores over time, with no significant differences between groups. MER was successfully performed under general anesthesia using remimazolam, maintaining high-quality recordings and patient safety. Conclusion: Robot-assisted asleep DBS significantly improves targeting accuracy while maintaining comparable clinical outcomes to manual frame-based DBS. Asleep DBS with MER is a safe and effective approach, enhancing patient comfort without compromising efficacy. These findings support the broader adoption of robotic techniques in DBS for PD.