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Deep brain stimulation: awake or asleep: it comes with a price either way
  1. Peter Warnke
  1. Correspondence to Professor Peter Warnke, Department of Neurosurgery, University of Chicago, Chicago, IL 60637, USA; pwarnke{at}

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A meta-analysis of deep brain stimulation techniques in Parkinson’s disease

Deep brain stimulation (DBS) for motor symptoms in Parkinson’s disease (PD) is a treatment backed by class I evidence. Quite the exception looking at the plethora of neurosurgical treatments where no such evidence exists.

Still the functional neurosurgical community is plagued by two dominant questions among others: when to implement DBS during the course of the disease and how to perform DBS. Awake or asleep?

It is the second seemingly more technical question which Ho and colleagues try to answer with their manuscript in this journal1 by performing a meta-analysis of the available literature. Mind you—and that illuminates the problem right there—not a systematic review but a ‘critical comparison’.

The data available for review are too heterogeneous for a meaningful systematic review and represent class III evidence. The number of awake …

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