Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach

Maier, Franziska; Lewis, Catharine J.; Horstkoetter, Nina; Eggers, Carsten; Kalbe, Elke; Maarouf, Mohammad; Kuhn, Jens; Zurowski, Mateusz; Moro, Elena; Woopen, Christiane; Timmermann, Lars

doi:10.1136/jnnp-2012-303670

Cited by 109 publications

(113 citation statements)

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“…7,8 Similar to our study, a prior study 7 incorporated a semi-structured interview into their methods to better understand patients' expectations and postoperative subjective perceived benefit; however, this study did not incorporate patient-reported severity ratings that would have allowed more detailed quantitative assessment of perceived benefit. In contrast, another report 8 provided detailed quantitative assessment of patients' For repeated-measures data, the F statistic is the time main effect from mixed effects regression models.…”

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confidence: 89%

“…2 Although there is consensus among some DBS teams that patients' goals for the upcoming neurosurgery should be assessed routinely, [3][4][5][6] there has been relatively little investigation of how successful DBS is in addressing patients' goals for surgery or the relationship between patients' stated goals for surgery and other standard clinical research (SCR) metrics. 7,8 Despite studies demonstrating the positive benefits of DBS on motor symptoms and quality of life, [9][10][11] some have provocatively argued that patients may not be as pleased with the outcomes of DBS as the treating physicians. 12,13 This satisfaction gap suggests that SCR measures may not fully capture patients' goals with respect to outcome and argues for the need for a more systematic assessment of patients' individually defined goals for DBS and patients' perceived satisfaction with DBS in addressing those goals.…”

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confidence: 99%

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Insights gleaned by measuring patients' stated goals for DBS

et al. 2017

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Objective: To report prospective repeated measures data detailing the perceived benefit of deep brain stimulation (DBS) on the most commonly cited symptom and activity goals identified by patients with Parkinson disease.Methods: Fifty-two participants were recruited from a consecutive series. Participants completed a semi-structured interview soliciting their symptom and behavioral goals and corresponding visual analog scales measuring perceived symptom severity and limits to goal attainment. Severity ratings were completed prior to and at 2 times following DBS. Changes in severity over time were assessed using a mixed effects linear model. The pattern of relationships between the severity ratings and standard clinical research (SCR) measures routinely administered were examined using Pearson correlations. Results:The most common symptom goals were improvements in tremor, gait, and nonmotor symptoms, whereas the most frequent behavioral goals related to interpersonal relationships, work, and avocational pursuits. Most severity ratings were significantly correlated with each other but not with the SCR measures. Significant improvements were evident on all SCR measures after DBS. Participants' severity ratings for their symptom and behavioral goals improved significantly over time although not all severity ratings changed in the same manner.Conclusions: These data illustrate that improvements in participants' individually defined goals were evident over time and that some of these improvements occurred in areas in which the benefits associated with DBS are not as well-documented. The participants' severity ratings were not redundant with SCR measures, suggesting that novel and potentially important information can be gleaned by systematically assessing patients' goals.

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confidence: 89%

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confidence: 99%

Insights gleaned by measuring patients' stated goals for DBS

et al. 2017

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“…No complications were reported. A detailed description of the Cologne STN-DBS procedure can be found elsewhere [27]. To verify electrode positions, the individual anterior commissure-posterior commissure coordinates (x, y, z) of patients' electrodes were determined using the STP3 software (Stryker Leibinger, Freiburg, Germany).…”

Section: Dbs Routinementioning

confidence: 99%

Deep brain stimulation and cognitive decline in Parkinson’s disease: The predictive value of electroencephalography

et al. 2015

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Some Parkinson's disease (PD) patients treated with subthalamic nucleus deep brain stimulation (STN-DBS) develop new-onset cognitive decline. We examined whether clinical EEG recordings can be used to predict cognitive deterioration in PD patients undergoing STN-DBS. In this retrospective study, we used the Grand Total EEG (GTE)-score (short and total) to evaluate pre- and postoperative EEGs. In PD patients undergoing STN-DBS (N = 30), cognitive functioning was measured using Mini-Mental State Test and DemTect before and after surgery. Severity of motor impairment was assessed using the Unified Parkinson's Disease Rating Scale-III. Patients were classified into patients with or without cognitive decline after STN-DBS surgery. Epidemiological data, pre- and postoperative EEG recordings as well as neuropsychological and neurological data, electrode positions and the third ventricle width were compared. A logistic regression model was used to identify predictors of cognitive decline. Motor deficits significantly improved from pre- to post-surgery, while the mean GTE-scores increased significantly. Six patients developed cognitive deterioration 4-12 months postoperatively. These patients had significantly higher preoperative GTE-scores than patients without cognitive deterioration, although preoperative cognitive functioning was comparable. Electrode positions, brain atrophy and neurological data did not differ between groups. Logistic regression analysis identified the GTE-score as a significant predictor of postoperative cognitive deterioration. Data suggest that the preoperative GTE-score can be used to identify PD patients that are at high risk for developing cognitive deterioration after STN-DBS surgery even though their preoperative cognitive state was normal.

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“…Diese Auswirkungen waren nicht mit dem Operationserfolg korreliert, sondern resultierten zu einem großen Teil aus dem kognitiven und psychischen Anpassungsniveau des präoperativen Zustands. Auch die Erwartungen, die subjektive Lebensbilanz und die partnerschaftliche Situation determinierten entscheidend die bewerteten Langzeiteffekte der THS -die nach objektiver Messung in der Regel hervorragend ausfielen [Maier et al, 2013;Schüpbach et al, 2006;Agid et al, 2006]. [Hind et al, 2014;Moss-Morris et al, 2013;Knoop et al, 2012].…”

Section: Das Brain-computer-interface Als Methode Der Kompensationunclassified

Verhaltensmedizin in der Neurologie: State of the Art

Leplow

2014

Verhaltenstherapie

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Verhaltensmedizinische Interventionen setzen bei neurologischen Erkrankungen mit dem Ziel an, die gesellschaftliche Teilhabe so weit wie möglich zu erhalten oder wiederherzustellen. Dies kann über restitutive und kompensatorische Zugangswege mit oder ohne direkte Intervention am somatischen Substrat erfolgen. So lassen sich schlaganfallbedingte Paresen zumindest teilweise auch als Verlust des motorischen Gedächtnisses erklären. Durch lernpsychologisch begründete Interventionen ist neben der funktionellen Verbesserung auch eine Wiederherstellung der somatosensorischen Repräsentation möglich. Über EEG-Feedback-gestützte Brain-Computer-Interfaces kann dagegen die bei nahezu kompletten Lähmungen der Willkürmotorik ausgefallene Kommunikation mit der Umwelt kompensiert werden. Therapeutische Maßnahmen, die nicht direkt am somatischen Substrat ansetzen, zielen entweder auf die Wechselwirkung zwischen kurzfristigen, symptomatischen Verschlechterungen und situativen Auslösern oder auf den emotionalen und behavioralen Umgang mit einer somatischen Erkrankung. So ist eine situationsspezifische Symptomkontrolle unter anderem bei Anfallserkrankungen mit oder ohne Neurofeedback-Unterstützung möglich. Darüber hinaus kann die Behandlung psychischer Beschwerden und Störungen heute bei fast allen neurologischen Erkrankungen indiziert sein. Deshalb sollen mit diesem Beitrag die vielfältigen Möglichkeiten herausgestellt werden, die bereits jetzt zur verhaltensmedizinischen Unterstützung der Selbstregulation bei ganz unterschiedlichen neurologischen Krankheitsbildern zur Verfügung stehen.

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Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach

Cited by 109 publications

References 40 publications

Insights gleaned by measuring patients' stated goals for DBS

Insights gleaned by measuring patients' stated goals for DBS

Deep brain stimulation and cognitive decline in Parkinson’s disease: The predictive value of electroencephalography

Verhaltensmedizin in der Neurologie: State of the Art

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