Journal of Neurology

, 256:83

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

  • Elena Moro
  • Niels Allert
  • Roberto Eleopra
  • Jean-Luc Houeto
  • Tra-Mi Phan
  • Herman Stoevelaar
  • International Study Group onReferral Criteria for DBS

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


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.


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.


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.


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 in clinical practice need to be further determined.

Key words

Parkinson’s disease deep brain stimulation appropriateness method decision support 

Copyright information

© Steinkopff-Verlag 2009

Authors and Affiliations

  • Elena Moro
    • 1
  • Niels Allert
    • 2
  • Roberto Eleopra
    • 3
  • Jean-Luc Houeto
    • 4
  • Tra-Mi Phan
    • 5
  • Herman Stoevelaar
    • 6
  • International Study Group onReferral Criteria for DBS
  1. 1.Movement Disorders CenterUniversity of Toronto, UHN, Toronto Western HospitalTorontoCanada
  2. 2.Neurologisches Rehabilitationszentrum GodeshoheBonn-Bad GodesbergGermany
  3. 3.Ospedale Umberto 1Dept. of NeurologyVenezia MestreItaly
  4. 4.Poitiers UniversityDept. of NeurologyPoitiers CedexFrance
  5. 5.Medtronic InternationalTolochenazSwitzerland
  6. 6.Ismar HealthcareCentre for Decision Analysis and SupportLierBelgium

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