gms | German Medical Science

Objective: Estimated 10-15% of PD-patients suffer from motor-fluctuations, medically refractory tremor or medication side-effects. Those patients improve from DBS-surgery. However only about 1-2% of all PD-patients in Germany receive DBS-surgery although the risk for severe surgical complications is low (0.8% for symptomatic ICBs in a large German multicentre survey). The objective of this survey was to understand those factors that prevent the majority of PD-patients in Germany to be referred to a specialised centre.

Method: A questionnaire regarding personal awareness of DBS was created and sent to 2267 neurologists in private practice in Germany. The questionnaires contained both, multiple choice and open questions. All the received forms were then digitised and evaluated with SPSS and a descriptive analysis of the data was performed.

Results: 15.7% of the neurologists replied to our questionnaire. 98.8% of the neurologists knew DBS. 83.5% felt capable of handling DBS patients postoperatively. 78.5% declared to know the clinical reasons to recommend DBS to PD-patients. However concerning the clinical target symptoms for DBS in PD-patients (motor-fluctuations, tremor and medication side-effects), only 49.4% of the neurologists could actively describe at least one specific criterion, 20.9% mentioned two and 1.5% could state three. The likelihood of complications was estimated as 8.6% for dysarthria, 5.9% for ICB and 3.9% for weight gain (mean values). With 49.7% DBS-induced personality change was the most frequently marked concern of the respondents.

Conclusions: A high number of neurologists might not recognize suitable DBS-candidates, because they do not actively know the clinical target criteria for DBS-surgery. Furthermore our results show that the referring neurologists estimate the likelihood for symptomatic ICBs about 10-fold higher as supported by the literature. These two aspects document a lack of education of primary-care neurologists about this procedure as a possible reason for a rather reluctant patient-referral. Concerns about postoperative follow-up however were negligible for the treating neurologists.