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Underutilization of deep brain stimulation for Parkinson’s disease? A survey on possible clinical reasons

Authors
  • Lange, Max1, 2
  • Mauerer, Josef1
  • Schlaier, Jürgen1, 2
  • Janzen, Annette2, 3
  • Zeman, Florian4
  • Bogdahn, Ulrich3
  • Brawanski, Alexander1
  • Hochreiter, Andreas1
  • 1 University Medical Center Regensburg, Department of Neurosurgery, Franz-Josef-Strauss Allee 11, Regensburg, 93053, Germany , Regensburg (Germany)
  • 2 University Medical Center Regensburg, Center for Deep Brain Stimulation, Regensburg, Germany , Regensburg (Germany)
  • 3 University Medical Center Regensburg, Department of Neurology, Regensburg, Germany , Regensburg (Germany)
  • 4 University Medical Center Regensburg, Center for Clinical Studies, Regensburg, Germany , Regensburg (Germany)
Type
Published Article
Journal
Acta Neurochirurgica
Publisher
Springer-Verlag
Publication Date
Mar 03, 2017
Volume
159
Issue
5
Pages
771–778
Identifiers
DOI: 10.1007/s00701-017-3122-3
Source
Springer Nature
Keywords
License
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Abstract

BackgroundOnly 10% of the up to 15% of patients with advanced Parkinson’s disease (PD) eligible for deep brain stimulation (DBS) are referred to specialized centers. This survey evaluated the reasons for the reluctance of patients and referring physicians regarding DBS.MethodsTwo different questionnaires containing multiple choice and open verbalized questions were developed, one for neurologists and one for patients with PD. The first questionnaire was sent to 87 neurologists in private practice in the catchment area of the authors’ medical center, the second to patient support groups in the same region with the help of the German Parkinson Association.ResultsOf the addressed neurologists, 56.3% completed the questionnaire; 61.2% of them estimated the risk of intracerebral hemorrhage as the most severe complication at 4.3% on average; 30.6% were concerned about patients developing mood changes or depression after DBS. Only 16.3% felt unable to care for patients after DBS; 61.2% already had personal experience with patients after DBS and reported good clinical outcome in 90.0% of patients. Although 87.8% claimed to know the specific criteria for DBS, only 40.8% could actively describe them. Only 14.0% could state each of the three main criteria. Of the 46 patients, 88.1% completing the questionnaire had obtained information on DBS from regional patient organizations and 54.8% also from a physician; 44.7% assumed the risk of severe complications to be ≥5.0%. Not being satisfied with their medical treatment was reported by 22.2%, of whom more than 70% considered DBS a further treatment option.ConclusionsThe latter numbers indicate that treating neurologists tend to overestimate the reluctance of their patients to undergo DBS. Therefore, education of patients and neurologists should be improved and give more realistic figures on the actual outcomes and frequencies of possible complications.

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