Objective: To analyze why patients with Parkinson’s disease (PD) were excluded from candidate selection for subthalamic deep brain stimulation.

Background: Subthalamic deep brain stimulation (STN-DBS) is used for treatment of advanced PD. To achieve optimal surgical outcome, proper patient selection is important. As our PD center wants to develop a good protocol for candidate selection, we decide to analyze the percentage of subjects who were excluded and to identify the reasons of exclusion.

Methods: One hundred and twelve PD patients were evaluated for DBS candidate (2008-2016). All patients were hospitalized and evaluated according to Core Assessment Program for Surgical Interventional Therapies in Parkinson’s Disease (CAPSIT-PD) including clinical evaluation for PD criteria, a levodopa challenge test, a brain neuroimaging, a psychiatrist’s evaluation and a neuropsychological assessment. 

Results: A total of 31 subjects (27.7%) were not suitable for the surgery. The most frequent cause of exclusion was inadequate response (<33%) during levodopa challenge test; in 7 patients (22.6%), the mini-mental status exam were classified to dementia, while in 5 patients (16.1%), we found abnormal findings of neuropsychiatric disorders (four patients had depression, one had psychotic disorder). One patient (3.2%) showed severe stenosis of middle cerebral artery at the brain MRI.

Conclusions: More than one-fourth of the potentially suitable PD patients were excluded for STN DBS in our PD center. The importance of a careful candidate selection cannot be overemphasized.

References: Lopiano L, Rizzone M, Bergamasco B, et al. Deep brain stimulation of the subthalamic nucleus in PD: an analysis of the exclusion causes. J Neurol Sci. 2002 Mar 30;195(2):167-70.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/analysis-of-the-exclusion-causes-for-deep-brain-stimulation-in-parkinsons-disease-center-in-southern-taiwan/