Development and initial validation of a screening tool for Parkinson disease surgical candidates

Okun, Michael S.; Fernández, Hubert H.; Pedraza, Otto; Misra, Madhusmita; Lyons, Kelly E.; Pahwa, Rajesh; Tarsy, Daniel; Scollins, Lisa; Corapi, Kristin M.; Friehs, Gerhard; Grace, Janet; Romrell, Janet; Foote, Kelly D.

doi:10.1212/01.wnl.0000133122.14824.25

Cited by 88 publications

(58 citation statements)

References 6 publications

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“…For general (community) neurologists, it may be difficult to identify patients who could be good candidates for DBS and may be referred to a specialised centre for further evaluation. In a recent US centre review [15], 63 % of patients referred were refused for DBS which underlines the necessity of adequate pre-selection. Conversely, under-referral may also exist, withholding appropriate candidates the opportunity of being assessed by a specialised movement disorder centre.…”

Section: Introductionmentioning

confidence: 99%

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A decision tool to support appropriate referral for deep brain stimulation in Parkinson’s disease

Moro

Allert

Eleopra³

et al. 2009

J Neurol

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Section: Introductionmentioning

confidence: 99%

“…In order to support appropriate referral, Okun et al developed a screening tool (printed checklist) for DBS candidates [15]. Although an initial validation of this tool showed favourable results, its application in daily practice may be too complex and time-consuming for community neurologists.…”

Section: Introductionmentioning

confidence: 99%

A decision tool to support appropriate referral for deep brain stimulation in Parkinson’s disease

Moro

Allert

Eleopra³

et al. 2009

J Neurol

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“…The tool was used on a group of PD patients who had under gone interdisciplinary evaluation at a single DBS center in order to determine the validity of this screening questionnaire. The study found a significant correlation between the FLASQ-PD scores recorded and the ultimate decision of the DBS interdisciplinary team [41]. In another study, Moro et al [42] used the RAND method to evaluate surgical candidacy.…”

Section: Florida Surgical Questionnaire-pd and Rand Methods For Screementioning

confidence: 95%

Surgical Treatment of Parkinson's Disease: Patients, Targets, Devices, and Approaches

Shukla

Okun

2014

Neurotherapeutics

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Surgical treatment for Parkinson's disease (PD) has evolved from ablative procedures, within a variety of brain regions, to implantation of electrodes into specific targets of the basal ganglia. Electrode implantation surgery, referred to as deep brain stimulation (DBS), is preferred to ablative procedures by many experts owing to its reversibility, programmability, and the ability to be safely performed bilaterally. Several randomized clinical studies have demonstrated the effectiveness of DBS surgery for control of PD symptoms. Many brain targets, including the subthalamic nucleus and the globus pallidus internus, have emerged as potentially effective, with each target being closely associated with important pros and cons. Selection of appropriate PD candidates through a methodical interdisciplinary screening is considered a prerequisite for a successful surgical outcome. Despite recent growth in DBS knowledge, there is currently no consensus on the ideal surgical technique, the best surgical approach, and the most appropriate surgical target. DBS is now targeted towards treating specific PD-related symptoms in a given individual, and not simply addressing the disease with one pre-defined approach. In this review we will discuss the historical aspects of surgical treatments, the selection of an appropriate DBS candidate, the current surgical techniques, and recently introduced DBS-related technologies. We will address important pre-and postoperative issues related to DBS. We will also discuss the lessons learned from the randomized clinical studies for DBS and the shifting paradigm to tailor to a more patient-centered and symptom-specific approach.

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“…It is important to make a distinction between idiopathic PD and atypical parkinsonism that is seen in other neurologic disorders, such as progressive supranuclear palsy and corticobasal degeneration. In idiopathic PD, dopaminergic therapy and DBS are generally effective, while in the atypical syndromes they are not [54][55][56]. The severity of PD at a given time point is quantified using measures such as the Unified PD Rating Scale (UPDRS), which includes both patient reported and The DBS lead has been placed into the right thalamus, and the patient is being asked to trace a spiral on a clipboard.…”

Section: Pdmentioning

confidence: 99%

Deep Brain Stimulation for Movement Disorders

Larson

2014

Neurotherapeutics

111

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Deep brain stimulation (DBS) is an implanted electrical device that modulates specific targets in the brain resulting in symptomatic improvement in a particular neurologic disease, most commonly a movement disorder. It is preferred over previously used lesioning procedures due to its reversibility, adjustability, and ability to be used bilaterally with a good safety profile. Risks of DBS include intracranial bleeding, infection, malposition, and hardware issues, such migration, disconnection, or malfunction, but the risk of each of these complications is low-generally ≤ 5% at experienced, large-volume centers. It has been used widely in essential tremor, Parkinson's disease, and dystonia when medical treatment becomes ineffective, intolerable owing to side effects, or causes motor complications. Brain targets implanted include the thalamus (most commonly for essential tremor), subthalamic nucleus (most commonly for Parkinson's disease), and globus pallidus (Parkinson's disease and dystonia), although new targets are currently being explored. Future developments include brain electrodes that can steer current directionally and systems capable of "closed loop" stimulation, with systems that can record and interpret regional brain activity and modify stimulation parameters in a clinically meaningful way. New, image-guided implantation techniques may have advantages over traditional DBS surgery.

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Development and initial validation of a screening tool for Parkinson disease surgical candidates

Cited by 88 publications

References 6 publications

A decision tool to support appropriate referral for deep brain stimulation in Parkinson’s disease

A decision tool to support appropriate referral for deep brain stimulation in Parkinson’s disease

Surgical Treatment of Parkinson's Disease: Patients, Targets, Devices, and Approaches

Deep Brain Stimulation for Movement Disorders

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