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

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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 Parkinson’s 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.

About the authors

Ekaterina V. Bril’

Russian Medical Academy of Continuing Postgraduate Education; N.N. Burdenko National Medical Research Center of Neurosurgery

Author for correspondence.
Email: e.brill@inbox.ru
ORCID iD: 0000-0002-6524-4490

Cand. Sci. (Med.), Assoc. Prof., Department of neurology; Head

Россия, Moscow; 123098, Russia, Moscow, Marshala Novikova str., 23

Аleksey A. Tomskiy

N.N. Burdenko National Medical Research Center of Neurosurgery

Email: e.brill@inbox.ru
ORCID iD: 0000-0002-2120-0146

Cand. Sci. (Med.), Head, Group of functional neurosurgery

Россия, Moscow

Anna A. Poddubskaya

N.N. Burdenko National Medical Research Center of Neurosurgery

Email: e.brill@inbox.ru
ORCID iD: 0000-0002-5776-3442

neuropsychologist, neurologist, Group of functional neurosurgery

Россия, Moscow

Anna A. Gamaleya

N.N. Burdenko National Medical Research Center of Neurosurgery

Email: e.brill@inbox.ru
ORCID iD: 0000-0002-6412-8148

neurologist, Group of functional neurosurgery

Россия, Moscow

Natalya V. Fedorova

Russian Medical Academy of Continuing Postgraduate Education

Email: e.brill@inbox.ru
ORCID iD: 0000-0003-2168-2138

D. Sci. (Med.), Prof., Department of neurology

Россия, Moscow

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