SP 7. How to address the poor treatment acceptance for deep brain stimulation in Parkinson’s disease

Abstract

Question Deep Brain stimulation (DBS) is a widely established, effective and well-tolerated treatment for Parkinson’s disease (PD). The patients’ way to receive this treatment usually consists of two steps: first, general neurologists refer them to a specialized DBS center where they undergo further diagnostic assessment and the final decision for or against this treatment is made. Electronic tools are available to support general neurologists in the selection of DBS candidates. Nevertheless, even after being preselected as an appropriate candidate, the majority of patients refused to be referred to a DBS center (Wachter et al., J Neurol 2011;258:641–646). Patients and methods Two projects were initiated to increase the treatment acceptance of DBS for PD: (A) A collaboration of 20 general neurologists and two movement disorder specialists at the University Hospital Dusseldorf was established. (B) 51 general neurologists located all over Germany were trained to use the electronic preselection tool STIMULUS and were handed out newly developed information materials. In both projects, appropriate DBS candidates were preselected. Their acceptance or refusal to undergo further diagnostic assessment at a DBS center was documented within a 16 months follow-up period. Further, several clinical characteristics and details of the patient briefing were collected and analyzed to identify factors which were predictive for patients’ decisions. Results (A) 912 PD patients were examined by the movement disorder specialist together with the general neurologist. In 92 cases (10.1%), a referral to undergo further diagnostic assessment at the University Hospital Dusseldorf was recommended. Within 16 months, 69 (70.4%) of those patients showed up in the specialized DBS center. (B) 264 patients were identified as appropriate candidates for DBS, using the electronic preselection tool STIMULUS and 114 (43.2%) had accepted to be referred to a DBS center within a 16 month follow-up period. The patients’ decisions were significantly influenced by their age, their classification as an akinetic-rigid type and when mentioning a potential reduction of dopaminergic side effects as well as the optimal time frame for DBS during the clarification talk. Conclusion Consultation visits by movement disorder specialists in collaboration with general neurologists substantially improved the treatment acceptance of PD patients for DBS. A training of general neurologists in combination with adequate information material might be a low-cost and effective alternative option. Both findings indicate the importance of a clarification talk to be crucial in order to increase the treatment acceptance for DBS. This assumption is supported by the talks’ topics side effects of dopaminergic medication and optimal time frame which were significantly related to a higher rate of acceptance if mentioned.