Global Variability in Deep Brain Stimulation Practices for Parkinson’s Disease

Abstract

IntroductionDeep brain stimulation (DBS) has become a standard treatment option for select patients with Parkinson’s disease (PD). The selection process and surgical procedures employed have, to date, not been standardized.MethodsA comprehensive 58-question web-based survey was developed with a focus on DBS referral practices and peri-operative management. The survey was distributed to the Parkinson’s Foundation Centers of Excellence, members of the International Parkinson’s Disease and Movement Disorders Society, and the Parkinson Study Group (Functional Neurosurgery Working Group) between December 2015 and May 2016.ResultsThere were 207 individual respondents (20% response rate) drawn from 59 countries and 6 continents, of whom 64% received formal training in DBS. Thirteen percent of centers reported that DBS could proceed despite a confidence level of < 50% for PD diagnosis. A case-based approach to DBS candidacy was applied in 51.3% of centers without a cut-off for levodopa-responsiveness. Surprisingly, 33% of centers regularly used imaging for diagnostic confirmation of idiopathic PD. Thirty-one percent of centers reported that neuropsychological evaluation did not affect DBS target selection. Approximately half of the respondents reported determination of DBS candidacy based on a multidisciplinary committee evaluation and 1/3rd reported that a committee was used for target selection. Eight percent of respondents felt that psychosocial factors should not impact DBS candidacy nor site selection. Involvement of allied health professionals in the preoperative process was sparse. There was high variability in preoperative education about DBS outcome expectations. Approximately half of the respondents did not utilize a “default brain target,” though STN was used more commonly than GPi. Specific DBS procedure techniques applied, as well as follow-up timelines, were highly variable.ConclusionResults revealed high variability on the best approaches for DBS candidate selection, brain target selection, procedure type, and postoperative practices. Cognitive and mood assessments were underutilized. There was low reliance on multidisciplinary teams or psychosocial factors to impact the decision-making process. There were small but significant differences in practice across global regions, especially regarding multidisciplinary teams. The wide variability of responses across multiple facets of DBS care highlights the need for prospective studies to inform evidence-based guidelines.

Caregivers' burden and deep brain stimulation for Parkinson disease: A systematic review of qualitative studies

“…However, it is worth noting that none of these programs is specifically tailored to the unique challenges posed by DBS treatment. A specific educational program has been developed by surgical teams in France (ParkEduStim), which might help to align patient expectations with potential results from surgery [47, 53]. There remains a clear need for developing and implementing future programs specifically designed to address the unique challenges CGs face in the context of DBS treatment, informed by CB‐related evidence.…”

Automatic extraction of upper-limb kinematic activity using deep learning-based markerless tracking during deep brain stimulation implantation for Parkinson’s disease: A proof of concept study

“…Ruralized and non-Western under-resourced clinics would benefit greatly from this simple approach, as it is interpretable with minimal training. Thus, this methodology could augment accessibility and success of diagnostic and therapeutic approaches for individuals experiencing neurodegenerative, neuromuscular, or alike disorders [ 33 , 46 , 47 ].…”

“…These results suggest that markerless tracking tools are a promising method for tracking kinematics in the OR and aiding in optimal DBS placement. This tool is particularly lucrative for under-resourced clinics; an investigation of non-Western deep-brain stimulation centers often in underdeveloped countries revealed that in some clinics, decisions on DBS candidacy and placement did not include a movement disorders neurologist (10.4%) or did not involve a committee whatsoever (53.5%) [ 46 ]. 33% of clinics did not employ a neurologist for DBS programming and 69% reported underutilization of DBS due to poor clinician knowledge [ 47 ].…”

Computational Models in Deep Brain Stimulation : Patient‐Specific Simulations, Tractography, and Group Analysis

“…Therefore, single-centre PSM analysis will be sensitive to targeting protocol and might produce a higher rate of false negatives in out-of-sample validation. Mahajan et al, [179] showed large global variability of the DBS practice in PD patients, which further indicated the importance of multi-center analysis. Boutet et al, [177] showed a high PSM-based prediction rate for PD sub-symptoms using in-sample validation (92-100%) and external clinic validation dataset (96-100%).…”