Objective: To survey how Deep Brain Stimulation (DBS) Centers handle referrals and peri-operative (surgical and non-surgical) treatment of persons with Parkinson’s disease (PD).

Background: Currently there are no comprehensive consensus recommendations for DBS patient referral, pre- and post-operative evaluation and management. A multi-site survey aimed at clarifying real world best practices will be the first step toward the formulation of a standard of care.

Methods: A 58-question web-based survey was developed to ascertain various aspects of the Deep Brain Stimulation referral pathway including (but not limited to): initial referral, necessity of movement disorder physician evaluation, average number of referrals and procedures per center, indications, adequacy of medication trials, utilizing objective measures, neuropsychiatric evaluation, rehabilitation personnel, DBS Committee utilization and constitution, implant site selection, intra- and post-operative imaging and post-operative management. The survey was distributed by National Parkinson Foundation to Centers of Excellence in the United States. Subsequent international distribution of the survey is planned.

Results: The results revealed important practice trends across busy DBS centers. The average minimum required duration of PD expected before offering DBS was 5-6 years though a sizeable minority indicated no minimum disease duration. All centers perform some type of screening for mood disorders before DBS, though an objective measure was not always applied. The majority of centers do not utilize an overall objective rating scale to determine DBS candidacy. A formal neurocognitive battery was required at 96% of centers. The default brain target (STN vs. GPi) for each DBS centers was modified 11-25% and 26-50% of the time based on mood evaluation or neurocognitive evaluations, respectively. The decision to proceed with DBS was most commonly arrived at by consensus building in 77% of DBS centers. Twenty-eight percent of DBS centers used MRI guidance. STN was chosen as the target > 60% while GPi was used in <40% of cases. Procedures were staged an average of 11-25% of the time.

Conclusions: This best practices data will be used to develop consensus recommendations for PD DBS.

« Back to 2016 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/a-multi-site-survey-of-parkinsons-disease-deep-brain-stimulation-center-best-practice-moving-toward-a-standard-of-care-for-dbs/