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Auffret M, Weiss D, Stocchi F, Vérin M, Jost WH. Access to device-aided therapies in advanced Parkinson's disease: navigating clinician biases, patient preference, and prognostic uncertainty. J Neural Transm (Vienna) 2023; 130:1411-1432. [PMID: 37436446 PMCID: PMC10645670 DOI: 10.1007/s00702-023-02668-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023]
Abstract
Device-aided therapies (DAT), which include deep brain stimulation and pump-based continuous dopaminergic stimulation with either levodopa or apomorphine, are among the major advances in the clinical management of Parkinson's disease (PD). Although DAT are being increasingly offered earlier in the disease course, their classical indication remains advanced PD. Theoretically, every patient should be offered transition to DAT when faced with refractory motor and nonmotor fluctuations and functional decline. Worldwide clinical reality is far from these ideal, and, therefore, question the "real-world" equal opportunity of access to DAT for PD patients with advanced PD-even within a single health care system. Differences in access to care, referral pattern (timing and frequency), as well as physician biases (unconscious/implicit or conscious/explicit bias), and patients' preferences or health-seeking behaviour are to be considered. Compared to DBS, little information is available concerning infusion therapies, as well as neurologists' and patients' attitudes towards them. This viewpoint aims to be thought-provoking and to assist clinicians in moving through the process of DAT selection, by including in their decision algorithm their own biases, patient perspective, ethical concerns as well as the current unknowns surrounding PD prognosis and DAT-related long-term side effects for a given patient.
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Affiliation(s)
- Manon Auffret
- France Développement Electronique (FDE), Monswiller, France.
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France.
- Behavior and Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital and University of Rennes, Rennes, France.
| | - Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Fabrizio Stocchi
- University San Raffaele Roma and Institute of Research and Medical Care IRCCS San Raffaele Roma, Rome, Italy
| | - Marc Vérin
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France
- Behavior and Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital and University of Rennes, Rennes, France
- Neurology Department, Pontchaillou University Hospital, rue Henri Le Guilloux, 35000, Rennes, France
| | - Wolfgang H Jost
- Parkinson-Klinik Ortenau, Kreuzbergstr. 12-16, 77709, Wolfach, Germany
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Characterizing the trends in patient demographics, complications, and short-term outcomes after deep brain stimulation procedures. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Cabrera LY, Young Han C, Ostendorf T, Jimenez-Shahed J, Sarva H. Neurologists' Attitudes Toward Use and Timing of Deep Brain Stimulation. Neurol Clin Pract 2021; 11:506-516. [PMID: 34992957 PMCID: PMC8723941 DOI: 10.1212/cpj.0000000000001098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to explore current perspectives and attitudes of general neurologists and movement disorder specialists toward deep brain stimulation (DBS) for Parkinson disease (PD), focusing on perspectives on its earlier use in the clinical course of the disease. METHODS We designed a 30-question online survey comprised of Likert-type, multiple choice, and rank-order questions, which was distributed to 932 neurologist members of the American Academy of Neurology. We analyzed clinicians' sociodemographic information, treatment patterns used for patients with PD, reasons for and against patient referral for DBS, and general attitudes toward DBS. Data were analyzed using descriptive and inferential statistics. RESULTS We received 164/930 completed surveys (completion rate of 18%). Overall, most respondents agreed that DBS was more useful after the appearance of motor complications and that DBS utilization offered better management of PD than medication alone. However, respondents were divided on issues like minimum duration of disease needed to consider DBS as a treatment option and timing of DBS referral relative to disease progression. Specifically, differences between movement disorder specialists and general neurologists were seen in medication management of symptoms and dyskinesia. CONCLUSIONS There remains a lack of consensus on several aspects of DBS, including medical management before offering DBS and the appropriate timing of its consideration for patients. Given the effect of such lack of consensus on patients' outcomes and recent evidence on positive DBS results, it is essential to update DBS professional guidelines with a focus on medical management and the timely use of DBS.
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Affiliation(s)
- Laura Yenisa Cabrera
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Catherine Young Han
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Tasha Ostendorf
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Joohi Jimenez-Shahed
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Harini Sarva
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
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Testini P, Sarva H, Schwalb J, Barkan S, Cabrera LY. Neurosurgeons perspective on the shift towards earlier use of deep brain stimulation for Parkinson disease. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Das S, Matias CM, Ramesh S, Velagapudi L, Barbera JP, Katz S, Baldassari MP, Rasool M, Kremens D, Ratliff J, Liang TW, Wu C. Capturing Initial Understanding and Impressions of Surgical Therapy for Parkinson's Disease. Front Neurol 2021; 12:605959. [PMID: 33746873 PMCID: PMC7970030 DOI: 10.3389/fneur.2021.605959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/01/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Deep Brain Stimulation (DBS) is an underutilized surgical therapy for Parkinson's Disease (PD). Both physician and patient hesitancies have been described as potential barriers to DBS, but the specifics of patient perceptions of DBS have not been well-characterized in the general PD population. Objective: To characterize the understanding and impressions of surgical therapy in PD patients prior to formal surgical evaluation. Methods: A 30-question survey assessing impressions of surgical therapy for PD and understanding of DBS for PD was administered to PD patients seen at an urban movement disorders clinic. Results: One hundred and two patients completed the survey. When asked if they would undergo a hypothetical risk-free, curative brain surgery for PD, 98 patients responded "yes." Patients were more agreeable to "reversible," "minimally-invasive," and "incisionless" surgery. 51.2% thought DBS is an "effective" treatment for PD, 76.6% thought it was "invasive," and 18.3% thought it was "reversible." 45.2% reported fear of being awake during DBS surgery. Regarding costs, 52.4% were concerned that DBS was "very expensive" or "not covered by insurance." Initial source of information and perceived treatment effectiveness were not associated with concerns about DBS effectiveness or threats to normality. Negative perceptions of past surgery were associated with concerns about DBS altering mood and personality. Conclusion: Overall, patients expressed concerns regarding procedural efficacy, invasiveness, cost, and irreversibility-independent of the original source of information. Future studies are required to allow us to better understand the impact of these initial findings on DBS hesitancy and underutilization.
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Affiliation(s)
- Somnath Das
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Caio M. Matias
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Sunidhi Ramesh
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Lohit Velagapudi
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Julie P. Barbera
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Samantha Katz
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Michael P. Baldassari
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Mohammad Rasool
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Daniel Kremens
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jeffrey Ratliff
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Tsao-Wei Liang
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Chengyuan Wu
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
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Aldred J, Anca-Herschkovitsch M, Antonini A, Bajenaru O, Bergmann L, Bourgeois P, Cubo E, Davis TL, Iansek R, Kovács N, Kukreja P, Onuk K, Pontieri FE, Robieson W, Siddiqui MS, Simu M, Standaert DG, Chaudhuri KR. Application of the '5-2-1' screening criteria in advanced Parkinson's disease: interim analysis of DUOGLOBE. Neurodegener Dis Manag 2020; 10:309-323. [PMID: 32873195 DOI: 10.2217/nmt-2020-0021] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: A Delphi expert consensus panel proposed that fulfilling ≥1 of the '5-2-1 criteria' (≥five-times daily oral levodopa use, ≥two daily hours with 'Off' symptoms or ≥one daily hour with troublesome dyskinesia) suggests advanced Parkinson's disease (PD). Patients & methods: DUOdopa/Duopa in Patients with Advanced PD - a GLobal OBservational Study Evaluating Long-Term Effectiveness (DUOGLOBE) - is a single-arm, postmarketing, observational, long-term effectiveness study of levodopa-carbidopa intestinal gel (LCIG) for advanced PD. Results: This 6-month interim analysis (n = 139) affirms that most (98%) enrolled patients fulfill ≥1 of the 5-2-1 criteria. These patients responded favorably to LCIG treatment. Safety was consistent with other LCIG studies. Conclusion: In advanced PD patients, the 5-2-1 criteria generally aligns with clinician assessment. Clinical Trial Registration: NCT02611713 (ClinicalTrials.gov).
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Affiliation(s)
- Jason Aldred
- Selkirk Neurology & Inland Northwest Research, Spokane, 610 S Sherman St #201 & 208, Spokane, WA 99202, USA
| | - Marieta Anca-Herschkovitsch
- Department of Neurology, Edith Wolfson Medical Center Affiliated to Tel Aviv University, 62 Ha-Lokhamim St, Holon, Israel
| | - Angelo Antonini
- Department of Neuroscience, Padua University, 5 - 35128 Padova, Padua, Veneto, Italy
| | - Ovidiu Bajenaru
- Department of Neurology, University of Medicine & Pharmacy "Carol Davila", Bulevardul Eroii Sanitari 8, Bucharest, Romania
| | - Lars Bergmann
- AbbVie, Inc., 1 Waukegan Rd, North Chicago, IL 60064, USA
| | - Paul Bourgeois
- Department of Neurology AZ Groeninge, President Kennedylaan 4, Kortrijk, Belgium
| | - Esther Cubo
- Neurology Department, Hospital Universitario Burgos, Av. Islas Baleares, 3, Burgos, Spain
| | - Thomas L Davis
- Department of Neurology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Robert Iansek
- Kingston Centre, Monash Health, 400 Warrigal Rd, Melbourne, Victoria, Australia
| | - Norbert Kovács
- Department of Neurology, University of Pecs, 48-as tér 1, Pecs, Hungary
| | - Pavnit Kukreja
- AbbVie, Inc., 1 Waukegan Rd, North Chicago, IL 60064, USA
| | - Koray Onuk
- AbbVie, Inc., 1 Waukegan Rd, North Chicago, IL 60064, USA
| | - Francesco E Pontieri
- Department of Neurological Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 5, Rome, Italy
| | | | - Mustafa S Siddiqui
- Department of Neurology, Wake Forest School of Medicine, 475 Vine St, Winston Salem, NC 27101, USA
| | - Mihaela Simu
- Department of Neurology, Victor Babes University of Medicine & Pharmacy, Piaţa Eftimie Murgu 2, Timisoara, Romania
| | - David G Standaert
- Department of Neurology, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL 35294, USA
| | - K Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, King's College & King's College Hospital, Denmark Hill, London, UK
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Abstract
OBJECTIVES To compare long-term survival of Parkinson's disease (PD) patients with deep brain stimulation (DBS) to matched controls, and examine whether DBS was associated with differences in injurious falls, long-term care, and home care. METHODS Using administrative health data (Ontario, Canada), we examined DBS outcomes within a cohort of individuals diagnosed with PD between 1997 and 2012. Patients receiving DBS were matched with non-DBS controls by age, sex, PD diagnosis date, time with PD, and a propensity score. Survival between groups was compared using the log-rank test and marginal Cox proportional hazards regression. Cumulative incidence function curves and marginal subdistribution hazard models were used to assess effects of DBS on falls, long-term care admission, and home care use, with death as a competing risk. RESULTS There were 260 DBS recipients matched with 551 controls. Patients undergoing DBS did not experience a significant survival advantage compared to controls (log-rank test p = 0.50; HR: 0.89, 95% CI: 0.65-1.22). Among patients <65 years of age, DBS recipients had a significantly reduced risk of death (HR: 0.49, 95% CI: 0.28-0.84). Patients receiving DBS were more likely than controls to receive care for falls (HR: 1.56, 95% CI: 1.19-2.05) and home care (HR: 1.59, 95% CI: 1.32-1.90), while long-term care admission was similar between groups. CONCLUSIONS Receiving DBS may increase survival for younger PD patients who undergo DBS. Future studies should examine whether survival benefits may be attributed to effects on PD or the absence of comorbidities that influence mortality.
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