Cynthia S Kubu1, Thomas Frazier2, Scott E Cooper2, Andre Machado2, Jerrold Vitek2, Paul J Ford2. 1. From the Center for Neurological Restoration (C.S.K.), Neuroethics Program (P.J.F.), Center for Pediatric Behavioral Health (T.F.), and Center for Neurological Restoration (A.M.), Cleveland Clinic, OH; and Department of Neurology (S.E.C., J.V.), University of Minnesota, Minneapolis. kubuc@ccf.org. 2. From the Center for Neurological Restoration (C.S.K.), Neuroethics Program (P.J.F.), Center for Pediatric Behavioral Health (T.F.), and Center for Neurological Restoration (A.M.), Cleveland Clinic, OH; and Department of Neurology (S.E.C., J.V.), University of Minnesota, Minneapolis.
Abstract
OBJECTIVE: To determine using a repeated-measures, prospective design whether deep brain stimulation (DBS) results in changes in the importance of symptom and behavioral goals individually identified by patients with Parkinson disease (PD) before DBS surgery. METHODS: Fifty-two participants recruited from a consecutive series completed a semistructured interview soliciting their rank-ordered symptom and behavioral goals and corresponding visual analog scales measuring perceived symptom severity and limits to goal attainment. Rank orders were reassessed at 2 times after DBS. Changes in rank order over time were examined with χ2 analyses. The relationships between change in symptom severity/limits to behavioral goal attainment and change in rank order were examined with mixed-effects linear regression models. RESULTS: Most participants changed the rank order of their symptom (81%) and behavioral (77%) goals 3 months after DBS surgery. Change in rank order of symptom goals was significantly related to change in severity ratings such that improvements in self-reported symptom severity were associated with reductions in rank. In contrast, no such relationship was evident for the behavioral goals. CONCLUSION: These data illustrate how patients' primary goals for DBS shift early in stimulation and highlight the important differences between symptom and behavioral goals. Changes in the rank order of symptom goals were related to changes in symptom severity, whereas subtler shifts in behavioral goals were unrelated to improvements after DBS. This observation suggests that DBS does not affect goals that may be more reflective of core personal values. The findings provide empiric data that can help improve the informed consent process.
OBJECTIVE: To determine using a repeated-measures, prospective design whether deep brain stimulation (DBS) results in changes in the importance of symptom and behavioral goals individually identified by patients with Parkinson disease (PD) before DBS surgery. METHODS: Fifty-two participants recruited from a consecutive series completed a semistructured interview soliciting their rank-ordered symptom and behavioral goals and corresponding visual analog scales measuring perceived symptom severity and limits to goal attainment. Rank orders were reassessed at 2 times after DBS. Changes in rank order over time were examined with χ2 analyses. The relationships between change in symptom severity/limits to behavioral goal attainment and change in rank order were examined with mixed-effects linear regression models. RESULTS: Most participants changed the rank order of their symptom (81%) and behavioral (77%) goals 3 months after DBS surgery. Change in rank order of symptom goals was significantly related to change in severity ratings such that improvements in self-reported symptom severity were associated with reductions in rank. In contrast, no such relationship was evident for the behavioral goals. CONCLUSION: These data illustrate how patients' primary goals for DBS shift early in stimulation and highlight the important differences between symptom and behavioral goals. Changes in the rank order of symptom goals were related to changes in symptom severity, whereas subtler shifts in behavioral goals were unrelated to improvements after DBS. This observation suggests that DBS does not affect goals that may be more reflective of core personal values. The findings provide empiric data that can help improve the informed consent process.
Authors: Cynthia S Kubu; Scott E Cooper; Andre Machado; Thomas Frazier; Jerrold Vitek; Paul J Ford Journal: Neurology Date: 2016-12-02 Impact factor: 9.910
Authors: Hesham Abboud; Raja Mehanna; Andre Machado; Anwar Ahmed; Michal Gostkowski; Scott Cooper; Ilia Itin; Patrick Sweeney; Mayur Pandya; Cynthia Kubu; Darlene Floden; Paul J Ford; Hubert H Fernandez Journal: Mov Disord Clin Pract Date: 2014-10-10
Authors: Adolfo Ramirez-Zamora; James Giordano; Aysegul Gunduz; Jose Alcantara; Jackson N Cagle; Stephanie Cernera; Parker Difuntorum; Robert S Eisinger; Julieth Gomez; Sarah Long; Brandon Parks; Joshua K Wong; Shannon Chiu; Bhavana Patel; Warren M Grill; Harrison C Walker; Simon J Little; Ro'ee Gilron; Gerd Tinkhauser; Wesley Thevathasan; Nicholas C Sinclair; Andres M Lozano; Thomas Foltynie; Alfonso Fasano; Sameer A Sheth; Katherine Scangos; Terence D Sanger; Jonathan Miller; Audrey C Brumback; Priya Rajasethupathy; Cameron McIntyre; Leslie Schlachter; Nanthia Suthana; Cynthia Kubu; Lauren R Sankary; Karen Herrera-Ferrá; Steven Goetz; Binith Cheeran; G Karl Steinke; Christopher Hess; Leonardo Almeida; Wissam Deeb; Kelly D Foote; Michael S Okun Journal: Front Hum Neurosci Date: 2020-03-27 Impact factor: 3.169