Analysing the reasons for rejection of neurosurgery intervention in patients with Parkinson’s disease referred to an extrapyramidal movement disorders clinic

Abstract

We present findings of a 10-year retrospective study, analysing the reasons for rejection of neurosurgical intervention (deep brain stimulation or DBS) in patients with Parkinsons disease, who were referred to an extrapyramidal movement disorders clinic and then to a neurosurgery centre. It was found that after screening, 78.6% of patients referred as candidates for neurosurgical treatment to an extrapyramidal movement disorders clinic were rejected, while 21.4% of patients were referred to a neurosurgery centre, where 12% underwent surgery. The main reasons for rejecting potential DBS candidates were: early referral, inadequate pharmacotherapy, levodopa-resistant symptoms, atypical/secondary Parkinsonism, cognitive reasons, psychological reasons, comorbidity, abnormal MRI, poor response to levodopa medication and declined surgery. Furthermore, the number of self-referrals decreased, the number of patients referred by neurologists increased, the number of rejections of unsuitable DBS candidates decreased, and the number of suitable candidates referred to the extrapyramidal centre increased during the time period of 10 years. In addition, the number of patients who were referred to the neurosurgery centre and underwent surgery there increased, which suggests greater awareness of the selection criteria among doctors, as well increased knowledge and experience among neurologists in both primary healthcare and specialized centres.

Keywords

• parkinson’s disease
• deep brain stimulation
• neurostimulation
• electrode implantation in the brain
• reasons for refusal to perform surgery
• exclusion criteria
• extrapyramidal movement disorders clinic