Health Economics and Surgical Treatment for Parkinson's Disease in a World Perspective: Results from an International Survey

Abstract

Background: Most studies in the field of neurosurgical treatment for movement disorders have been published by a small number of leading centers in developed countries. This study aimed to investigate the clinical practice of stereotactic neurosurgery for Parkinson's disease (PD) worldwide. Methods: Neurosurgeons were contacted via e-mail to participate in a worldwide survey. The results obtained are presented in order of the countries' economic development according to the World Bank, as well as by the source of financial support. Results: A total of 353 neurosurgeons from 51 countries who had operated on 13,200 patients in 2009 were surveyed. Surgical procedures performed in high-income countries were more commonly financed by a public health care system. In contrast, in lower-middle-income and upper-middle-income countries, patients frequently financed surgeries themselves, and ablative surgeries were most commonly performed. Unexpectedly, ablative surgery is still used by about 65% of neurosurgeons, regardless of their country's economic status. Conclusions: This study provides a previously unavailable picture of the surgical aspects of PD across the globe in relation to health economics and sociodemographic factors. Global educational and training programs are warranted to raise awareness of economically viable surgical options for PD that could be adopted by public health care systems in lower-income countries.

Functional lesional neurosurgery for tremor: back to the future?

“…RF ablation influenced lesional functional neurosurgery more than any other method and is still widely used around the globe today 70. In principal, a RF electrode is introduced under stereotactic guidance via a burr hole to the target chosen to create a monopolar electrocoagulation lesion, and among stereotactic neurosurgeons, the original publication still serves as a guidance to the technical basis of the procedure 71.…”

Functional lesional neurosurgery for tremor—a protocol for a systematic review and meta-analysis

“…During the past two decades, lesional interventions, although performed worldwide, 13 were largely superseded in the academic setting by stimulation technology, 14 which contributed dramatically to our understanding of tremor pathoaetiology. [15][16][17][18] Since the introduction of Gamma Knife (GK), incision-less functional neurosurgery, that is, lesion placement through the intact skull, is a possibility 12 and the recent addition of MRI-guided high-intensity focused ultrasound (MRIgFUS) [19][20][21][22] has again stimulated interest in this field.…”

Radiofrequency Ablation of Prelemniscal Radiations for the Treatment of Non-Parkinsonian Tremor

“…Both procedures may be equally effective to control tremor; however, DBS is considered the gold standard in the treatment of involuntary movements since it is less invasive, adjustable along the years and reversible in case it is associated with undesirable side effects. Nevertheless, cases where patients or health services cannot afford the cost of neurostimulators [1] or cases when patients are living away from centers with infrastructure to provide adequate service for adjusting stimulation parameters or detect possible complications from DBS therapy, and cases where DBS electrodes had to be explanted due to complications, ablative procedures such as RF [2,3], radiosurgery [4] or magnetic resonance imaging (MRI)-guided focused ultrasound lesioning [5] are valid therapies. RF ablation is based on the generation of thermal energy secondary to the creation of an electric field, and it is known that the size of the lesion is a function of the temperature reached at the contacts of the electrode as well as the time of heating exposure and the monopolar or bipolar electrode type [6][7][8].…”