Journal of Neurology

, 256:83

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

Authors

    • Movement Disorders CenterUniversity of Toronto, UHN, Toronto Western Hospital
  • Niels Allert
    • Neurologisches Rehabilitationszentrum Godeshohe
  • Roberto Eleopra
    • Ospedale Umberto 1Dept. of Neurology
  • Jean-Luc Houeto
    • Poitiers UniversityDept. of Neurology
  • Tra-Mi Phan
    • Medtronic International
  • Herman Stoevelaar
    • Ismar HealthcareCentre for Decision Analysis and Support
  • International Study Group onReferral Criteria for DBS
ORIGINAL COMMUNICATION

DOI: 10.1007/s00415-009-0069-1

Cite this article as:
Moro, E., Allert, N., Eleopra, R. et al. J Neurol (2009) 256: 83. doi:10.1007/s00415-009-0069-1

Abstract

Background and objective

Although Deep Brain Stimulation (DBS) has been proven to be an effective treatment for patients with advanced Parkinson’s disease (PD), it may be difficult for general neurologists to identify appropriate candidates for this procedure. We developed an electronic decision tool that can assist neurologists in deciding which PD patients should be referred for DBS consideration.

Methods

Using the RAND/UCLA Appropriateness Method, an international expert panel assessed the appropriateness of referral for 972 theoretical patient profiles. Panel results were embedded in an electronic decision support tool which displays the panel statement on referral (appropriate, inappropriate and uncertain) after completion of the patient profile.

Results

Referral was considered appropriate for 33 % of the theoretical profiles. Logistic regression showed excellent internal consistency of the ratings (predictive value 92 %). Symptom severity (OFF-symptoms, dyskinesias, refractory tremor) and PD duration were positively associated with the panel judgment that referral is appropriate. Presence of levodopa-resistant axial symptoms, age ≥ 70 years and presence of cognitive impairment showed the strongest negative impact.

Conclusions

The RAND/UCLA method proved to be useful in determining the appropriate criteria for DBS referral. Validity and applicability of the decision tool (accessible via http://test.stimulus-dbs.org) in clinical practice need to be further determined.

Key words

Parkinson’s diseasedeep brain stimulationappropriateness methoddecision support

Copyright information

© Steinkopff-Verlag 2009