Comprehensive, Multidisciplinary Deep Brain Stimulation Screening for Parkinson Patients: No Room for "Short Cuts"
Comprehensive, Multidisciplinary Deep Brain Stimulation Screening for Parkinson Patients: No Room for "Short Cuts"
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DOI：
10.1002/mdc3.12090
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发表时间：
2014-12-01
影响因子：
4
通讯作者：
Fernandez, Hubert H.
中科院分区：
文献类型：
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作者：
Abboud, Hesham;Mehanna, Raja;Fernandez, Hubert H.
仔细，往往繁琐，筛选是帕金森病（PD）DBS评价的基本组成部分。它通常涉及大脑MRI，神经心理学测试，神经学，外科和精神病学评估，以及“ON/OFF”运动测试。鉴于DBS现在已经成为晚期PD的标准治疗方法，临床医生在筛选和转诊患者进行DBS时的舒适度和信心有所提高，我们想知道我们现在是否可以简化冗长的评估过程。我们回顾了2006年至2011年在我们中心接受DBS评估的所有PD患者，并分析了排除和退出的原因，尽管通过了筛选过程。共有223名接受DBS评价的PD患者完成了图表。仅131例（58.7%）患者成功植入。六十一（27.3%）的患者在筛选后因认知功能显著下降而被排除（32.7%），疾病早期有用药调整的余地（29.5%），行为功能障碍（21.3%），疑似继发性帕金森综合征或不典型帕金森综合征（13.1%），PD，但左旋多巴反应差（11.4%），不切实际的目标（9.8%），PD主要轴向症状（6.5%），显著的合并症（6.5%），或异常脑成像（3.2%）。此外，31例（13.9%）患者获准手术，但选择不手术（18例）、失访（12例）或被医疗保险拒绝（1例）。通过仔细筛选，由于各种原因，相当比例的手术候选人继续被确定为不太合适。这突出表明，继续需要一个全面的、多学科的筛选过程。
Careful, often cumbersome, screening is a fundamental part of DBS evaluation in Parkinson's disease (PD). It often involves a brain MRI, neuropsychological testing, neurological, surgical, and psychiatric evaluation, and "ON/OFF" motor testing. Given that DBS has now been a standard treatment for advanced PD, with clinicians' improved comfort and confidence in screening and referring patients for DBS, we wondered whether we can now streamline our lengthy evaluation process. We reviewed all PD patients evaluated for DBS at our center between 2006 and 2011 and analyzed the reasons for exclusion and for dropping out despite passing the screening process. A total of 223 PD patients who underwent DBS evaluation had complete charting. Only 131 (58.7%) patients were successfully implanted. Sixty-one (27.3%) patients were excluded after screening because of significant cognitive decline (32.7%), early disease with room for medication adjustment (29.5%), behavioral dysfunction (21.3%), suspected secondary parkinsonism or atypical parkinsonism syndrome (13.1%), PD, but with poor levodopa response (11.4%), unrealistic goals (9.8%), PD with predominant axial symptoms (6.5%), significant comorbidities (6.5%), or abnormal brain imaging (3.2%). In addition, 31 (13.9%) patients were cleared for surgery, but either chose not have it (18 patients), were lost to follow-up (12 patients), or were denied by medical insurance (1 patient). Through careful screening, a significant percentage of surgical candidates continue to be identified as less suitable because of a variety of reasons. This underscores the continued need for a comprehensive, multidisciplinary screening process.