Interdisciplinary Parkinson’s Disease Deep Brain Stimulation Screening and the Relationship to Unintended Hospitalizations and Quality of Life

Abstract

ObjectiveTo investigate the impact of pre-operative deep brain stimulation (DBS) interdisciplinary assessments on post-operative hospitalizations and quality of life (QoL).BackgroundDBS has been utilized successfully in Parkinson’s disease (PD) for the treatment of tremor, rigidity, bradykinesia, off time, and motor fluctuations. Although DBS is becoming a more common management approach there are no standardized criteria for selection of DBS candidates, and sparse data exist to guide the use of interdisciplinary evaluations for DBS screening. We reviewed the outcomes of the use of an interdisciplinary model which utilized seven specialties to pre-operatively evaluate potential DBS candidates.MethodsThe University of Florida (UF) INFORM database was queried for PD patients who had DBS implantations performed at UF between January 2011 and February 2013. Records were reviewed to identify unintended hospitalizations, falls, and infections. Minor and major concerns or reservations from each specialty were previously documented and quantified. Clinical outcomes were assessed through the use of the Parkinson disease quality of life questionnaire (PDQ-39), and the Unified Parkinson’s Disease Rating Score (UPDRS) Part III.ResultsA total of 164 cases were evaluated for possible DBS candidacy. There were 133 subjects who were approved for DBS surgery (81%) following interdisciplinary screening. There were 28 cases (21%) who experienced an unintended hospitalization within the first 12 months following the DBS operation. The patients identified during interdisciplinary evaluation with major or minor concerns from any specialty service had more unintended hospitalizations (93%) when compared to those without concerns (7%). When the preoperative “concern” shifted from “major” to “minor” to “no concerns,” the rate of hospitalization decreased from 89% to 33% to 3%. A strong relationship was uncovered between worsened PDQ-39 at 12 months and increased hospitalization.ConclusionsUnintended hospitalizations and worsened QOL scores correlated with the number and severity of concerns raised by interdisciplinary DBS evaluations. The data suggest that detailed screenings by interdisciplinary teams may be useful for more than just patient selection. These evaluations may help to stratify risk for post-operative hospitalization and QoL outcomes.

Three-Year Gait and Axial Outcomes of Bilateral STN and GPi Parkinson’s Disease Deep Brain Stimulation

“…Patients were eligible for enrollment if they had received a diagnosis of idiopathic PD from a movement disorders-trained neurologist and underwent bilateral DBS implantation surgery at the University of Florida from 2002 to 2015. The selection of target-either the GPi or STN-was reached by a standard of care interdisciplinary screening and discussion (Higuchi et al, 2016). Inclusion criteria were: (1) bilateral placement of DBS; (2) fulfill the UK PD Society Brain Bank Clinical diagnosis criteria (Hughes et al, 1992); and (3) patients must have received both on-med and off-med scores in the preoperative assessment, 6-month (considered between 3-9 months) and 36-month postoperative (considered between 33-39 months).…”

Dorsal GPi/GPe Stimulation Induced Dyskinesia in a Patient with Parkinson’s Disease

“…3 Balancing the potential improvement in motor symptoms against the risk of SID is a particular challenge for clinicians and surgeons. GPI targeting is favored by some groups 4 for the treatment of disabling refractory levodopa-induced dyskinesia (LID) or as a rescue target in cases of severe disabling STN DBS-induced dyskinesia.…”

Combining NT3-overexpressing MSCs and PLGA microcarriers for brain tissue engineering: A potential tool for treatment of Parkinson's disease

“…Parkinson's disease (PD), the second most prevalent progressive neurodegenerative disorder of the aging central nervous system (CNS), is characterized by continuous and selective degeneration of dopaminergic neurons [1,2]. The current approaches for treatment of PD are the oral administration of Levadopa (L-Dopa) as a drug therapy method [3,4] and surgical procedures such as deep brain stimulation (DBS) [5]. Levadopa (L-Dopa), a precursor of dopamine, is mainly used in combination with a peripheral dopa decarboxylase inhibitor [6].…”