Abstract
ObjectiveTo investigate the relationship of our interdisciplinary screening process on post-operative unintended hospitalizations and quality of life.BackgroundThere are currently no standardized criteria for selection of appropriate Deep Brain Stimulation candidates and little hard data exists to support the use of any singular method.MethodsAn Essential Tremor cohort was selected from our institutional Deep Brain Stimulation database. The interdisciplinary model utilized seven specialties who pre-operatively screened all potential Deep Brain Stimulation candidates. Concerns for surgery raised by each specialty were documented and classified as none, minor, or major. Charts were reviewed to identify unintended hospitalizations and quality of life measurements at 1 year post-surgery.ResultsEighty-six percent (44/51) of the potential screened candidates were approved for Deep Brain Stimulation. Eight (18%) patients had an unintended hospitalization during the follow-up period. Patients with minor or major concerns raised by any specialty service had significantly more unintended hospitalizations when compared to patients without concerns (75% vs. 25%, p < 0.005). The rate of hospitalization revealed a direct relationship to the “level of concern”; ranging from 100% if major concerns, 42% if minor concerns, and 7% if no concerns raised, p = 0.001. Quality of life scores significantly worsened in patients with unintended hospitalizations at 6 (p = 0.046) and 12 months (p = 0.027) when compared to baseline scores. No significant differences in tremor scores between unintended and non-unintended hospitalizations were observed.ConclusionsThe number and level of concerns raised during interdisciplinary Deep Brain Stimulation screenings were significantly related to unintended hospitalizations and to a reduced quality of life. The interdisciplinary evaluation may help to stratify risk for these complications. However, data should be interpreted with caution due to the limitations of our study. Further prospective comparative and larger studies are required to confirm our results.
Highlights
The number and level of concerns raised during interdisciplinary Deep Brain Stimulation screenings were significantly related to unintended hospitalizations and to a reduced quality of life
Essential tremor (ET) is one of the most common movement disorders with a reported prevalence varying from 0.4% to 3.9% in population-based studies [1], and has an incidence which increases with age [2]
Though tremors are successfully treated with medications in about 50% of patients for those with medically-refractory and disabling tremors, deep brain stimulation (DBS) of the ventralis intermedius nucleus (Vim) of the thalamus has been shown to be effective in reducing the shaking by 50% to 90% at long-term follow-up [7, 8]
Summary
Essential tremor (ET) is one of the most common movement disorders with a reported prevalence varying from 0.4% to 3.9% in population-based studies [1], and has an incidence which increases with age [2]. While ET was classically considered a monosymptomatic tremor disorder, non-motor clinical symptoms, including cognitive and mood issues, are increasingly recognized as important features of the disease [4]. These symptoms frequently lead to a greater difficulty in performing activities of daily living (ADL) and this impacts negatively on quality of life (QOL) [5, 6]. There are currently no standardized criteria for selection of appropriate Deep Brain Stimulation candidates and little hard data exists to support the use of any singular method
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