1. Referring Parkinson’s disease patients for deep brain stimulation: a RAND/UCLA appropriateness study
- Author
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Michael Schüpbach, Christopher R. Honey, Tobias Wächter, Alan L Whone, Yasushi Shimo, Elena Moro, Niels Allert, Mya C. Schiess, Mauricio Rueda, Roberto Eleopra, Herman Stoevelaar, Peter Valkovič, Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Neuroradiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Department of Neurology - Movement Disorders Center, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Neurological Rehabilitation Center Godeshoehe, Ospedale 'Santa Maria della Misericordia' = University Hospital 'Santa Maria della Misericordia', Division of Neurosurgery, Departamento de Neurociencias, The University of Texas Medical School at Houston, Juntendo University School of Medicine, Department of Neurology, Frenchay Hospital, Centre for Decision Analysis and Support, [GIN] Grenoble Institut des Neurosciences (GIN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and University of British Columbia (UBC)
- Subjects
Male ,medicine.medical_specialty ,Deep brain stimulation ,Neurology ,Parkinson's disease ,Referral ,medicine.medical_treatment ,Clinical Neurology ,Disease ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Stage (cooking) ,Referral and Consultation ,Aged ,Neuroradiology ,Referral Consultation ,Aged, 80 and over ,Original Communication ,Consultation ,business.industry ,Parkinson Disease ,Middle Aged ,medicine.disease ,Gait ,RAND/UCLA appropriateness method ,3. Good health ,Practice Guidelines as Topic ,Physical therapy ,Parkinson’s disease ,Female ,[SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
International audience; In 2005, a European expert panel developed and validated an electronic tool to support the appropriate referral of patients with Parkinson’s disease (PD) for the consideration of deep brain stimulation (DBS). Since new evidence has become available over the last decade an update of the tool is necessary. A world-wide expert panel (71 neurologists and 11 neurosurgeons) used the RAND/UCLA Appropriateness Method to assess the appropriateness of referral for 1296 scenarios (9-point scale). Scenarios were permutations of 8 clinical variables relevant to the decision of referral. Appropriateness of referral was calculated on the basis of the median score and the extent of agreement. Compared to 2005, the impact of clinical variables on the appropriateness of referral was similar for severity of on–off fluctuations, dyskinesias and refractory tremor (positive association, p < 0.001), and cognitive impairment (negative association, p < 0.001). A relatively stronger negative impact was seen for levodopa-unresponsive gait and balance disturbances as well as older age, the latter most likely due to a higher cut-off value (75 versus 70 years in the previous study). The impact of PD duration on the appropriateness of referral was less pronounced than in 2005. The contribution of the newly included variable ‘non-motor side effects of anti-PD medication’ was very modest. Based on these results the panel produced new recommendations on the appropriateness of referral for the evaluation of DBS in PD patients. Differences from the previous study reflect the new clinical evidence, particularly related to the use of DBS in an earlier stage of PD. The validation of the updated recommendations is in progress.
- Published
- 2016
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