Attitudes toward use and timing of deep brain stimulation: a patient’s with DBS perspective

Cabrera, Laura Y.; Mitchell, Steven D.; Bender, Andrew R.; Tvedten, Erika; Sidiropoulos, Christos; Sarva, Harini

doi:10.1016/j.clineuro.2021.106553

Cited by 5 publications

(2 citation statements)

References 20 publications

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“…With a 2-3 year time window required to realise its full effects, patients would likely have to consider this treatment approach significantly earlier in their disease course, at a time when pharmacological interventions are still providing optimal benefit. There have been some challenges to the acceptance of deep brain stimulation at earlier stages in the disease ( Cabrera et al, 2021 ), so progress here may pave the way for earlier use of novel advanced therapies, such as cell transplantation. Cell transplantation is also perceived differently from deep brain stimulation, as more curative than symptomatic, although, of course, neither are cures.…”

Section: Positioning Cell Transplantation In the Therapeutic Landscapementioning

confidence: 99%

Defining the unknowns for cell therapies in Parkinson's disease

Lane

Lelos

2022

Disease Models &Amp; Mechanisms

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First-in-human clinical trials have commenced to test the safety and efficacy of cell therapies for people with Parkinson's disease (PD). Proof of concept that this neural repair strategy is efficacious is based on decades of preclinical studies and clinical trials using primary foetal cells, as well as a significant literature exploring more novel stem cell-derived products. Although several measures of efficacy have been explored, including the successful in vitro differentiation of stem cells to dopamine neurons and consistent alleviation of motor dysfunction in rodent models, many unknowns still remain regarding the long-term clinical implications of this treatment strategy. Here, we consider some of these outstanding questions, including our understanding of the interaction between anti-Parkinsonian medication and the neural transplant, the impact of the cell therapy on cognitive or neuropsychiatric symptoms of PD, the role of neuroinflammation in the therapeutic process and the development of graft-induced dyskinesias. We identify questions that are currently pertinent to the field that require further exploration, and pave the way for a more holistic understanding of this neural repair strategy for treatment of PD.

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Section: Positioning Cell Transplantation In the Therapeutic Landscapementioning

confidence: 99%

Defining the unknowns for cell therapies in Parkinson's disease

Lane

Lelos

2022

Disease Models &Amp; Mechanisms

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“…Cabrera et al . 7 explored the role of sociodemographic factors in DBS decision-making and found that patient satisfaction with DBS is associated with earlier acceptance of the intervention. On the other hand, reasons for not agreeing to earlier DBS included not exhausting other medication alternatives and managing symptoms effectively with current medication.…”

mentioning

confidence: 99%

Know DBS: patient perceptions and knowledge of deep brain stimulation in Parkinson’s disease

Salinas,

Yazdani,

Oblack

et al. 2024

Ther Adv Neurol Disord

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Introduction: Deep brain stimulation (DBS) is an established therapy for Parkinson’s disease (PD) that can significantly improve motor symptoms and quality of life. Despite its effectiveness, little is known about patient perceptions of DBS. Objectives: To evaluate patient perceptions of DBS for PD, focusing on understanding, satisfaction, and factors influencing their outlook. This study aims to enhance patient education and counseling by identifying key determinants of patient perceptions. Design: A patient survey. Methods: We surveyed 77 PD patients who had undergone DBS at multiple centers using a comprehensive questionnaire. The questionnaire included questions on demographic information, disease history, and detailed understanding about the indications for DBS, side effects, outlook, and other common misconceptions. We summarize data using measures of central tendency and dispersion appropriate to the data type (categorical, continuous, proportional) and model relationships among variables using fractional and linear regression methods. Results: Participants had a median age of 66 years, were predominantly male (66%), Caucasian (90%), well-educated (79% with at least college degrees), and had a disease duration of greater than 5 years (97%). They conveyed good understanding of the signs and symptoms addressed by DBS across the motor and non-motor domains and associated side effects. Regression analysis identified age, disease duration, and education level as key determinants of patient understanding and outlook of DBS. Conclusion: Our study provides a detailed understanding of patient perceptions of DBS for PD, including the benefits, challenges, and misconceptions. Our findings underscore the importance of identifying the causes of disparities in patient knowledge and perceptions regarding DBS to tailor patient counseling and ensure optimal treatment outcomes.

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Access to device-aided therapies in advanced Parkinson’s disease: navigating clinician biases, patient preference, and prognostic uncertainty

et al. 2023

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Device-aided therapies (DAT), which include deep brain stimulation and pump-based continuous dopaminergic stimulation with either levodopa or apomorphine, are among the major advances in the clinical management of Parkinson’s disease (PD). Although DAT are being increasingly offered earlier in the disease course, their classical indication remains advanced PD. Theoretically, every patient should be offered transition to DAT when faced with refractory motor and nonmotor fluctuations and functional decline. Worldwide clinical reality is far from these ideal, and, therefore, question the “real-world” equal opportunity of access to DAT for PD patients with advanced PD—even within a single health care system. Differences in access to care, referral pattern (timing and frequency), as well as physician biases (unconscious/implicit or conscious/explicit bias), and patients’ preferences or health-seeking behaviour are to be considered. Compared to DBS, little information is available concerning infusion therapies, as well as neurologists’ and patients’ attitudes towards them. This viewpoint aims to be thought-provoking and to assist clinicians in moving through the process of DAT selection, by including in their decision algorithm their own biases, patient perspective, ethical concerns as well as the current unknowns surrounding PD prognosis and DAT-related long-term side effects for a given patient.

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Attitudes toward use and timing of deep brain stimulation: a patient’s with DBS perspective

Cited by 5 publications

References 20 publications

Defining the unknowns for cell therapies in Parkinson's disease

Defining the unknowns for cell therapies in Parkinson's disease

Know DBS: patient perceptions and knowledge of deep brain stimulation in Parkinson’s disease

Access to device-aided therapies in advanced Parkinson’s disease: navigating clinician biases, patient preference, and prognostic uncertainty

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