title: Rationale and clinical pearls for primary care doctors referring patients for deep brain stimulation.
abstract: BACKGROUND
  Deep brain stimulation (DBS) is a surgical treatment involving the implantation of a brain lead connected to a chest-based neurostimulator similar to a cardiac pacemaker. The device can be programmed to deliver electrical impulses to neuromodulate abnormal brain circuitry in disorders such as Parkinson's disease (PD), essential tremor (ET), and dystonia. As the number of patients receiving DBS surgery increases, it will be important for primary care doctors to identify reasonable DBS candidates for referral to an experienced center.
  
  
  OBJECTIVE
  To provide primary care physicians with a rationale and also to provide clinically useful pearls for referral of potential DBS candidates.
  
  
  METHODS
  A complete PubMed review of the literature.
  
  
  RESULTS
  This review will be focused on PD and ET and will address the following issues: what are the common motor and nonmotor symptoms? What is the evidence supporting the use of DBS in PD and ET? What is the importance of a multi- or interdisciplinary DBS team for patient selection? What can be done to improve success in identifying and referring potential DBS candidates?
  
  
  CONCLUSIONS
  DBS is a highly effective therapy for select candidates with PD and ET. The most important factor influencing DBS outcome is proper patient selection. It will be critical as DBS continues to be more commonly employed for primary care doctors to select candidates from their practices as appropriate referrals to specialized centers.
authors.affiliation: University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Fla., USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Martinez-Ramirez
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation; D004421:Dystonia / Q000175:diagnosis / Q000628:therapy; D020329:Essential Tremor / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D009069:Movement Disorders / Q000175:diagnosis / Q000628:therapy*; D010300:Parkinson Disease / Q000175:diagnosis / Q000628:therapy; D018579:Patient Selection; D011320:Primary Health Care; D012017:Referral and Consultation