Capturing Initial Understanding and Impressions of Surgical Therapy for Parkinson's Disease

Abstract

Background: Deep Brain Stimulation (DBS) is an underutilized surgical therapy for Parkinson's Disease (PD). Both physician and patient hesitancies have been described as potential barriers to DBS, but the specifics of patient perceptions of DBS have not been well-characterized in the general PD population.Objective: To characterize the understanding and impressions of surgical therapy in PD patients prior to formal surgical evaluation.Methods: A 30-question survey assessing impressions of surgical therapy for PD and understanding of DBS for PD was administered to PD patients seen at an urban movement disorders clinic.Results: One hundred and two patients completed the survey. When asked if they would undergo a hypothetical risk-free, curative brain surgery for PD, 98 patients responded “yes.” Patients were more agreeable to “reversible,” “minimally-invasive,” and “incisionless” surgery. 51.2% thought DBS is an “effective” treatment for PD, 76.6% thought it was “invasive,” and 18.3% thought it was “reversible.” 45.2% reported fear of being awake during DBS surgery. Regarding costs, 52.4% were concerned that DBS was “very expensive” or “not covered by insurance.” Initial source of information and perceived treatment effectiveness were not associated with concerns about DBS effectiveness or threats to normality. Negative perceptions of past surgery were associated with concerns about DBS altering mood and personality.Conclusion: Overall, patients expressed concerns regarding procedural efficacy, invasiveness, cost, and irreversibility—independent of the original source of information. Future studies are required to allow us to better understand the impact of these initial findings on DBS hesitancy and underutilization.

Toward asleep DBS: cortico-basal ganglia spectral and coherence activity during interleaved propofol/ketamine sedation mimics NREM/REM sleep activity

“…At present, there is tension between the patient comfort and precise implantation of the lead during DBS surgery. Only a small fraction of eligible PD patients choose to undergo DBS surgery, partially due to fear of awake surgery 11 . Patients may be anxious or afraid during awake DBS procedure.…”

“…To accurately reach the target of the DBS lead, a neural navigation system that requires brain electrophysiological signals from the awake patient may be used 9 , 10 . Some patients avoid DBS therapy due to the fear of undergoing awake brain surgery 11 , leaving a wide gap for therapeutic improvement.…”

Mapping the Landscape of Equitable Access to Advanced Neurotechnologies in Canada

“…Beyond the opportunities identified in the present study, the development of cultural competencies within the Canadian neurological sciences community about diverse meanings of brain wellness and disease can support this movement. 13 Bi-directional approaches that directly engage patient communities are essential in this process given the evidence showing differences between how clinicians and patients perceive the risks, benefits, and invasiveness of the procedures, 37,38 as well as the enabling effects of patient education highlighted in the present study. Taken together, positive actions drawn from medical, legal, and ethical initiatives can improve care for culturally diverse patients living with severe, treatment refractory conditions, address historic distrust, achieve government support for equalizing access, and realize an ethically grounded future for advanced neuromodulatory and ablative technologies.…”

Ketamine Sedation Facilitates Asleep DBS: a multicenter retrospective study

“…The copyright holder for this this version posted December 14, 2021. ; https://doi.org/10.1101/2021.12.12.21267680 doi: medRxiv preprint responses, leading to sub-optimal surgical results in terms of lead accuracy, clinical outcome, patient's experience, and other surgical complications 17 .…”

“…Various sedative and anesthetic drugs have been shown to distort the typical MER signature of the STN, putting in favor fully awake anesthetic protocol 14–16 . Nevertheless, it is not uncommon for awake DBS cases to be altered or aborted due to marked anxiety and non-cooperative patient responses, leading to sub-optimal surgical results in terms of lead accuracy, clinical outcome, patient’s experience, and other surgical complications 17 .…”