gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Reasons for underutilisation of Deep Brain Stimulation (DBS) for Parkinson's Disease (PD): a clinical survey

Meeting Abstract

  • A. Hochreiter - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • J. Mauerer - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • A. Janzen - Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg
  • J. Schlaier - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • A. Brawanski - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • M. Lange - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.04.02

DOI: 10.3205/12dgnc047, URN: urn:nbn:de:0183-12dgnc0477

Published: June 4, 2012

© 2012 Hochreiter et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: It is estimated that 10–15% of PD-patients are DBS-candidates, although only about 10% of those DBS-eligible patients with advanced PD are referred to specialised centres. The objective of this survey was to unmask unrealistic fears and prejudices concerning DBS in patients and referring neurologists.

Methods: Two different questionnaires were created. One for neurologists and one for patients suffering from Parkinson disease. The first one was sent to 87 neurologists in private practice in the referring area around the authors' centre. The second one was circulated in the same region to the local patient support groups by the help of German Parkinson Association. The questionnaires contained both multiple choice and open questions. All the returned forms were then digitised and evaluated with SSPS and a descriptive analysis of the data was performed.

Results: 56.3% of the established neurologists replied to our questionnaire. 61.2% considered intracerebral haemorrhage to be the most severe complication, they estimated the likelihood of ICB to be 4.4% on the average. 83.7% of the neurologists felt capable of handling DBS patients postoperatively. 87.8% of the established neurologists declared that they know the indication for DBS. However, only 34.9% of these neurologists could actively describe specific criteria. From the patients we received 46 completed questionnaires. 88.1% stated that their source of information about DBS is the regional patient organization. 55.3% of the patients estimated the general complication rate in DBS to be 5% or lower, 44.7% of the patients suggested the likelihood of severe complications 5% or higher. 22.2% were not satisfied with their medical therapy, 70.0% of these consider DBS as an option in the further treatment of their disease.

Conclusions: The aim of this survey was to point out reasons for the reluctant referral of PD-patients to the DBS centre. Interestingly a relevant part of the established neurologists believes that they know the criteria for DBS indication, though their active reproduction of those ciriteria is limited. Overestimated complication rates in DBS are probably the reason for PD-patients' reluctance to accept this invasive treatment. Reasons for underutilisation for DBS maybe: 1) a lack of education among both patients and physicians about this procedure. 2) The fear of severe complications during or after the operation. Concerns about postoperative follow-up however, were negligible for the treating neurologists.