Prospective Nonrandomized TrialSelection of Deep Brain Stimulation Candidates in Private Neurology Practices: Referral May Be Simpler than a Computerized Triage System
Section snippets
INTRODUCTON
Appropriate patient selection is widely recognized as the first and most important step for successful deep brain stimulation (DBS) therapy in Parkinson’s disease (PD). Even so, there remains no standardized assessment tool that will accomplish a quick and appropriate DBS triage for private practice-based neurologists. One tool available to private practice neurologists is the previously publishedFlorida Surgical Questionnaire for Parkinson Disease (FLASQ-PD) (1). The FLASQ-PD was designed for
METHODS
The study was approved by the University of Florida Institutional Review Board, and all patients provided written informed consent. Participants included patients who were diagnosed by private practice neurologists with presumed levodopa responsive idiopathic PD during the years 2007–2010. Four private non-DBS neurology practices participated (Neurology Institute of Melbourne, P.A.; Tallahassee Memorial Neuroscience Center; Southeastern Integrated Medical, P.L.; and Neurology and Neurosurgery
Patient Characteristics
A total of 19 patients (three males and 16 females) were enrolled from four private neurological practices. The patient cohort was in its early sixties (mean age 62.7 years ± 8.9), well educated (13.6 years ± 2.8), and had symptoms for a decade (10.2 years ± 4.5). The Hoehn and Yahr stage was 2.6 ± 0.8. The levodopa equivalent dose (9,10) was 602.9 ± 168.4 mg. Sixteen out of 19 had tremor and 7/19 had dyskinesia. Table 2 shows the characteristics of the included patients and their DBS candidacy
DISCUSSION
Successful DBS surgery optimally includes a detailed interdisciplinary evaluation followed by an interdisciplinary discussion and stratification of risks and benefits for each individual DBS candidate. The use of a computerized screening tool should optimally detect all potential candidates. Although COMPRESS identified most candidates appropriately, there were some disagreements between COMPRESS and the movement disorders neurologist. Importantly, there was no substantial difference between
Acknowledgements
Funding for this study was provided by the Parkinson’s Alliance and infrastructure support for the Center was provided by the National Parkinson Foundation Center of Excellence.
Authorship Statements
Dr. Okun designed and conducted the study. Drs. Rodriguez, Unger, and Delgado and Ms. Hubmann, Swartz, and Merritt contributed patient recruitment, data collection, and data analysis. Dr. Oyama and Mr. Jones drafted the manuscript draft with important intellectual input from Drs. Doniger, Simon, Bowers, Foote, and
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Cited by (12)
Deep brain stimulation for Parkinson's disease - patient selection
2013, Handbook of Clinical NeurologyCitation Excerpt :Given the complexity of symptoms in most patients with advanced PD, the selection process should be implemented in specific centers, and should include a movement disorder neurologist, a neurosurgeon, a neuropsychologist, a psychiatrist, a neuroradiologist, and, in some cases, a neurophysiologist, an internist, and a PD nurse – all experts in DBS. A computerized DBS screening module and electronic decision-making tool (Moro et al., 2009), which can assist neurologists in deciding which patients with PD should be referred for DBS evaluation, has been developed, but the traditional triage by a neurologist specialized in movement disorders remains the gold standard (Oyama et al., 2012). In 1987, high-frequency stimulation was applied within the thalamus to improve tremors of different causes, because it mimicked the effect of thalamotomy, with the added advantages of reversibility and adjustability.
Tools and criteria to select patients with advanced Parkinson’s disease for device-aided therapies: a narrative review
2023, Journal of Neural TransmissionMovement Disorders and Patients Selection for Deep Brain Stimulation Surgery
2022, The Handbook of Neuromodulation (2 Volume Set): Volme 1Initial cognitive changes in Parkinson's disease
2018, Movement Disorders
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Financial support: Drs. Okun, Foote, and Fernandez, and Dr. Simon of the NeuroTrax Corporation, participated in the construction of the FLASQ-PD and COMPRESS software for DBS screening. Drs. Simon and Doniger are employees of NeuroTrax. Drs. Okun, Foote, and Fernandez currently have no royalty interest. <Correction added after online publication 29 February 2012: The original version of this article contained an error in Dr. Hubert H. Fernandez’s name. It has been corrected in this version.>