Laura Yenisa Cabrera1, Catherine Young Han1, Tasha Ostendorf1, Joohi Jimenez-Shahed1, Harini Sarva1. 1. Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York.
Abstract
OBJECTIVE: We sought to explore current perspectives and attitudes of general neurologists and movement disorder specialists toward deep brain stimulation (DBS) for Parkinson disease (PD), focusing on perspectives on its earlier use in the clinical course of the disease. METHODS: We designed a 30-question online survey comprised of Likert-type, multiple choice, and rank-order questions, which was distributed to 932 neurologist members of the American Academy of Neurology. We analyzed clinicians' sociodemographic information, treatment patterns used for patients with PD, reasons for and against patient referral for DBS, and general attitudes toward DBS. Data were analyzed using descriptive and inferential statistics. RESULTS: We received 164/930 completed surveys (completion rate of 18%). Overall, most respondents agreed that DBS was more useful after the appearance of motor complications and that DBS utilization offered better management of PD than medication alone. However, respondents were divided on issues like minimum duration of disease needed to consider DBS as a treatment option and timing of DBS referral relative to disease progression. Specifically, differences between movement disorder specialists and general neurologists were seen in medication management of symptoms and dyskinesia. CONCLUSIONS: There remains a lack of consensus on several aspects of DBS, including medical management before offering DBS and the appropriate timing of its consideration for patients. Given the effect of such lack of consensus on patients' outcomes and recent evidence on positive DBS results, it is essential to update DBS professional guidelines with a focus on medical management and the timely use of DBS.
OBJECTIVE: We sought to explore current perspectives and attitudes of general neurologists and movement disorder specialists toward deep brain stimulation (DBS) for Parkinson disease (PD), focusing on perspectives on its earlier use in the clinical course of the disease. METHODS: We designed a 30-question online survey comprised of Likert-type, multiple choice, and rank-order questions, which was distributed to 932 neurologist members of the American Academy of Neurology. We analyzed clinicians' sociodemographic information, treatment patterns used for patients with PD, reasons for and against patient referral for DBS, and general attitudes toward DBS. Data were analyzed using descriptive and inferential statistics. RESULTS: We received 164/930 completed surveys (completion rate of 18%). Overall, most respondents agreed that DBS was more useful after the appearance of motor complications and that DBS utilization offered better management of PD than medication alone. However, respondents were divided on issues like minimum duration of disease needed to consider DBS as a treatment option and timing of DBS referral relative to disease progression. Specifically, differences between movement disorder specialists and general neurologists were seen in medication management of symptoms and dyskinesia. CONCLUSIONS: There remains a lack of consensus on several aspects of DBS, including medical management before offering DBS and the appropriate timing of its consideration for patients. Given the effect of such lack of consensus on patients' outcomes and recent evidence on positive DBS results, it is essential to update DBS professional guidelines with a focus on medical management and the timely use of DBS.
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Authors: W M M Schuepbach; J Rau; K Knudsen; J Volkmann; P Krack; L Timmermann; T D Hälbig; H Hesekamp; S M Navarro; N Meier; D Falk; M Mehdorn; S Paschen; M Maarouf; M T Barbe; G R Fink; A Kupsch; D Gruber; G-H Schneider; E Seigneuret; A Kistner; P Chaynes; F Ory-Magne; C Brefel Courbon; J Vesper; A Schnitzler; L Wojtecki; J-L Houeto; B Bataille; D Maltête; P Damier; S Raoul; F Sixel-Doering; D Hellwig; A Gharabaghi; R Krüger; M O Pinsker; F Amtage; J-M Régis; T Witjas; S Thobois; P Mertens; M Kloss; A Hartmann; W H Oertel; B Post; H Speelman; Y Agid; C Schade-Brittinger; G Deuschl Journal: N Engl J Med Date: 2013-02-14 Impact factor: 91.245
Authors: Eugénie Lhommée; Lars Wojtecki; Virginie Czernecki; Karsten Witt; Franziska Maier; Lisa Tonder; Lars Timmermann; Thomas D Hälbig; Fanny Pineau; Franck Durif; Tatiana Witjas; Marcus Pinsker; Maximilian Mehdorn; Friederike Sixel-Döring; Andreas Kupsch; Rejko Krüger; Saskia Elben; Stephan Chabardès; Stéphane Thobois; Christine Brefel-Courbon; Fabienne Ory-Magne; Jean-Marie Regis; David Maltête; Anne Sauvaget; Jörn Rau; Alfons Schnitzler; Michael Schüpbach; Carmen Schade-Brittinger; Gunther Deuschl; Jean-Luc Houeto; Paul Krack Journal: Lancet Neurol Date: 2018-03 Impact factor: 44.182