Establishing a Standard of Care for Deep Brain Stimulation Centers in Canada

Panisset, Michel; Picillo, Marina; Jodoin, Nicolas; Poon, Yu‐Yan; Valencia-Mizrachi, Alejandro; Fasano, Alfonso; Munhoz, Renato P.; Honey, Christopher R.

doi:10.1017/cjn.2016.409

Cited by 9 publications

(4 citation statements)

References 74 publications

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“…In keeping with TWH protocols, 21,22 dopaminergic treatment was unchanged for the first month after surgery. During their first programming visit, patients were randomly assigned to either LD or DA monotherapy.…”

Section: Interventionsmentioning

confidence: 99%

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Levodopa Versus Dopamine Agonist after Subthalamic Stimulation in Parkinson's Disease

et al. 2020

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A BS TRACT: Background: No clinical trials have been specifically designed to compare medical treatments after surgery in Parkinson's disease (PD). Objective: Study's objective was to compare the efficacy and safety of levodopa versus dopamine agonist monotherapy after deep brain stimulation (DBS) in PD. Methods: Thirty-five surgical candidates were randomly assigned to receive postoperative monotherapy with either levodopa or dopamine agonist in a randomized, single-blind study. All patients were reevaluated in short-(3 months), mid-(6 months), and long-term (2.5 years) follow-up after surgery. The primary outcome measure was the change in the Non-Motor Symptoms Scale (NMSS) 3 months after surgery. Secondary outcome measures were the percentage of patients maintaining monotherapy, change in motor symptoms, and specific non-motor symptoms (NMS). Analysis was performed primarily in the intention-to-treat population. Results: Randomization did not significantly affect the primary outcome (difference in NMSS between treatment groups was 4.88 [95% confidence interval: −11.78-21.53, P = 0.566]). In short-and mid-term follow-up, monotherapy was safe and feasible in more than half of patients (60% in short-and 51.5% in mid-term follow-up), but it was more often possible for patients on levodopa. The ability to maintain dopamine agonist monotherapy was related to optimal contact location. In the long term, levodopa monotherapy was feasible only in a minority of patients (34.2%), whereas dopamine agonist monotherapy was not tolerated due to worsening of motor conditions or occurrence of impulse control disorders. Conclusions: This trial provides evidence for simplifying pharmacological treatment after functional neurosurgery for PD. The reduction in dopamine receptor agonists should be attempted while monitoring for occurrence of NMSs, such as apathy and sleep disturbances.

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Section: Interventionsmentioning

confidence: 99%

“…Enrolled patients underwent STN DBS according to the standard practice used at TWH. 21,22 Quadripolar electrodes (model 3387) connected to an implantable pulse generator (Activa PC or SC, Medtronic, Dublin, Ireland) were used for all patients.…”

Section: Interventionsmentioning

confidence: 99%

Levodopa Versus Dopamine Agonist after Subthalamic Stimulation in Parkinson's Disease

et al. 2020

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“…In most centers, it comprises neurologists (specialized in movement disorders and experienced in DBS programming), neurosurgeons, neuropsychologists, neuropsychiatrists, nurses, and administrative assistants. Their roles vary from center to center and are not formally established in guidelines, but should cover essential aspects including the adequate selection of candidates for surgery, arrangement and performance of all preoperative assessments and the surgery per se, immediate postoperative (including initial programming) and long-term care and device management 53,54 . We argue that the special dedication to these functions minimizes treatment failures and optimizes care for long-term troubleshooting 55 .…”

Section: What Are the Purposes And Benefits Of The Multidisciplinary mentioning

confidence: 99%

Decisions about deep brain stimulation therapy in Parkinson’s disease

Brandão

Grippe²,

Modesto³

et al. 2018

Arq. Neuro-Psiquiatr.

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Parkinson' s disease (PD), a hypokinetic movement disorder characterized by the classic tetrad of bradykinesia, rest tremor, plastic rigidity, and postural disturbances 1,2 , is a neurodegenerative disorder with an increasing impact on the Brazilian social and healthcare system, mirroring known demographic-epidemiological changes such as aging of the population and widening of the apex of the age pyramid 3,4 . Considering a prevalence of 3.3% in those aged 65 or older in the Brazilian population 5 , the country has at least 200,000 patients living with the disorder, a definitive challenge to the public health system. ABSTRACTParkinson's disease can be treated surgically in patients who present with motor complications such as fluctuations and dyskinesias, or medically-refractory disabling tremor. In this review, a group of specialists formulated suggestions for a preoperative evaluation protocol after reviewing the literature published up to October 2017. In this protocol, eligibility and ineligibility criteria for surgical treatment were suggested, as well as procedures that should be carried out before the multidisciplinary therapeutic decisions. The review emphasizes the need to establish "DBS teams", with professionals dedicated specifically to this area. Finally, surgical target selection (subthalamic nucleus or globus pallidus internus) is discussed briefly, weighing the pros and cons of each target.Keywords: Parkinson disease; deep brain stimulation; reference standards; basal ganglia; neurosurgical procedures. RESUMOA doença de Parkinson pode ser tratada cirurgicamente em pacientes que desenvolveram complicações motoras, como flutuações e discinesias, ou tremores refratários ao uso de medicação. Nesta revisão, um grupo de especialistas formulou sugestões para um protocolo de avaliação pré-operatória, depois de revisar a literatura publicada até outubro de 2017. Neste protocolo, são sugeridos critérios de elegibilidade e inadmissibilidade para tratamento cirúrgico, bem como procedimentos que devem ser realizados antes das decisões terapêuticas multidisciplinares. A revisão enfatiza a necessidade de estabelecer "equipes de DBS", com profissionais dedicados especialmente a esta área. Ao final, a seleção do alvo cirúrgico (núcleo subtalâmico ou globo pálido interno) é discutida brevemente, ponderando prós e contras de cada escolha.Palavras-chave: doença de Parkinson; estimulação cerebral profunda; padrões de referência; gânglios da base; procedimentos neurocirúrgicos.

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“…Thereafter, it describes in more detail the fuller presurgical evaluation process and especially the neuropsychological evaluation that remains a debated but almost universally accepted aspect of the presurgical evaluation. [24][25][26][27] The appropriateness of subthalamic vs pallidal, unilateral vs bilateral, and asleep vs awake surgery is also briefly discussed.…”

Section: Introductionmentioning

confidence: 99%

Deep-brain stimulation for Parkinson's disease: current perspectives on patient selection with an emphasis on neuropsychology

Tröster¹,

Ponce²,

Moguel‐Cobos³

2018

JPRLS

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For some persons with Parkinson's disease, deep-brain stimulation (DBS) is an effective treatment that enhances function and quality of life. It is critical that the preoperative evaluation process yields information that allows the treatment team to determine the likelihood that DBS (directed at a specific target) will be an effective and safe treatment for a given person and that the treatment will meet that person's goals and expectations. Such information allows the team and the patient to perform a cost-benefit analysis and the patient and family to make an informed decision about the potential appropriateness of DBS, and ultimately whether or not to undergo DBS or alternative treatments. We review the multidisciplinary DBS evaluation and education process in general (and by exemplar at Barrow Neurological Institute) engaging the patient with neurology, neuropsychology, neurosurgery, neuroscience nursing, and when needed, psychiatry, social work, and additional medical subspecialties. The review first covers screening, including two standardized instruments, and then the more detailed preoperative evaluation that ensues after screening. Neuropsychological issues in patient selection, and especially cognition, are emphasized, because they remain the most controversial and yet often underlie the judgment that DBS is not an appropriate treatment for a given patient. Outcome studies, perhaps via large, multisite patient registries, are needed to identify neuropsychological risks for unsatisfactory outcome and to define better which surgery (e.g., target, side, timing) is best for a given patient. Such studies would ultimately allow one to judge whether current selection criteria are adequate, need to be stricter, or can be relaxed, and, consequently ensure that the therapy is accessible to the maximum number of persons who will benefit from it without significant adverse effects.

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Establishing a Standard of Care for Deep Brain Stimulation Centers in Canada

Cited by 9 publications

References 74 publications

Levodopa Versus Dopamine Agonist after Subthalamic Stimulation in Parkinson's Disease

Levodopa Versus Dopamine Agonist after Subthalamic Stimulation in Parkinson's Disease

Decisions about deep brain stimulation therapy in Parkinson’s disease

Deep-brain stimulation for Parkinson's disease: current perspectives on patient selection with an emphasis on neuropsychology

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Establishing a Standard of Care for Deep Brain Stimulation Centers in Canada

Cited by 9 publications

References 74 publications

Levodopa Versus Dopamine Agonist after Subthalamic Stimulation in Parkinson's Disease

Levodopa Versus Dopamine Agonist after Subthalamic Stimulation in Parkinson's Disease

Decisions about deep brain stimulation therapy in Parkinson’s disease

Deep-brain stimulation for Parkinson&#39;s disease: current perspectives on patient selection with an emphasis on neuropsychology

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Product

Resources

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Deep-brain stimulation for Parkinson's disease: current perspectives on patient selection with an emphasis on neuropsychology