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. 2021 Dec;11(6):506-516.
doi: 10.1212/CPJ.0000000000001098.

Neurologists' Attitudes Toward Use and Timing of Deep Brain Stimulation

Laura Yenisa Cabrera  1 , Catherine Young Han  1 , Tasha Ostendorf  1 , Joohi Jimenez-Shahed  1 , Harini Sarva  1
Affiliations

Neurologists' Attitudes Toward Use and Timing of Deep Brain Stimulation

Laura Yenisa Cabrera et al. Neurol Clin Pract. 2021 Dec.

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.

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Figures

Figure 1
Figure 1. Management of Wearing-Off Effect by Clinician Type
CR = controlled release; DBS = deep brain stimulation; MAO-B = monoamine oxidase type B. *p < 0.05.
Figure 2
Figure 2. Management of Levodopa-Induced Dyskinesia by Clinician Type
COMT = catechol-O-methyltransferase; DBS = deep brain stimulation. *p < 0.05.
Figure 3
Figure 3. Top 5 Reasons for Deep Brain Stimulation Referral by Clinician Type
UPDRS = Unified Parkinson Disease Rating Scale. *p < 0.05.
Figure 4
Figure 4. Top 5 Reasons Against Deep Brain Stimulation Referral by Clinician Type
PD = Parkinson disease.
See this image and copyright information in PMC

References

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