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

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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.

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Authors and Affiliations

  1. Movement Disorders Center, University of Toronto, UHN, Toronto Western Hospital, 399 Bathurst Street, 7MCL 7-402, Toronto, ON, M5T 2S8, Canada

    Elena Moro

  2. Neurologisches Rehabilitationszentrum Godeshohe, Waldstraße 2–10, 53177, Bonn-Bad Godesberg, Germany

    Niels Allert

  3. Ospedale Umberto 1, Dept. of Neurology, Via Circonvallazione 50, 30174, Venezia Mestre, Italy

    Roberto Eleopra

  4. Poitiers University, Dept. of Neurology, 86021, Poitiers Cedex, France

    Jean-Luc Houeto

  5. Medtronic International, Route du Molliau, Case Postale, 1131, Tolochenaz, Switzerland

    Tra-Mi Phan

  6. Ismar Healthcare, Centre for Decision Analysis and Support, Duwijckstraat 17, 2500, Lier, Belgium

    Herman Stoevelaar

Authors
  1. Elena Moro
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  2. Niels Allert
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  3. Roberto Eleopra
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  4. Jean-Luc Houeto
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  5. Tra-Mi Phan
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  6. Herman Stoevelaar
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Consortia

International Study Group onReferral Criteria for DBS

Corresponding author

Correspondence to Elena Moro.

Additional information

* International Study Group on Referral Criteria for DBS: Niels Allert, Bonn, Germany; Philippe Damier, Nantes, France; Patricia Dowsey-Limousin, London, United Kingdom; Roberto Eleopra, Venice, Italy; Jan Herzog, Kiel, Germany; Jean-Luc Houeto, Poitiers, France; Elena Moro, Toronto, Canada; Karen Østergaard, Aarhus, Denmark; Patrick Santens, Ghent, Belgium; Francesc Valldeoriola, Barcelona, Spain; Hakan Widner, Lund, Sweden; Maurizio Zibetti, Turin, Italy.

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Moro, E., Allert, N., Eleopra, R. et al. A decision tool to support appropriate referral for deep brain stimulation in Parkinson’s disease. J Neurol 256, 83–88 (2009). https://doi.org/10.1007/s00415-009-0069-1

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  • DOI: https://doi.org/10.1007/s00415-009-0069-1

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