title: Validity and Efficacy of Screening Algorithms for Assessing Deep Brain Stimulation Candidacy in Parkinson Disease.
abstract: BACKGROUND
  Deep Brain Stimulation (DBS) for Parkinson disease (PD) may be underutilized because of limited access to care (most DBS surgeries are performed at specialized centers) or over-referral of poor candidates, leading to inequitable utilization of limited evaluative resources. There is a pressing need for a widely employable screening algorithm to aid in the evaluation of PD candidates for DBS.
  
  
  OBJECTIVE
  To compare the validity and efficacy of two published screening algorithms, the Florida Surgical Questionnaire for PD and Stimulus, to predict candidacy for DBS.
  
  
  METHODS
  We reviewed the clinical data at our DBS center for 147 consecutive PD DBS referrals between 9/1/2007 and 12/31/2011. Florida Surgical Questionnaire and Stimulus scores were applied retrospectively through a chart review of the Movement Disorder neurologist's initial clinical evaluation. The validity and accuracy of these two algorithms in predicting candidacy for DBS was compared to the decision to offer DBS surgery by our multidisciplinary DBS team.
  
  
  RESULTS
  Of the 130 consecutive PD referrals who presented for initial evaluation, 50 were offered DBS after a standardized multidisciplinary evaluation. The Stimulus scale was a superior screening tool for predicting PD DBS candidacy in these referrals [Area under the Receiver operating curve = 0.8088] compared to the Florida Surgical Questionnaire for PD [Area under the Receiver operating curve = 0.6285].
  
  
  CONCLUSIONS
  In this single center study, Stimulus was a more appropriate screening measure than the Florida Surgical Questionnaire for PD to assess DBS candidacy for PD.
authors.affiliation: Department of Neurology, University of California San Francisco, San Francisco, CA ; Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veteran's Affairs Medical Center, San Francisco, CA.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Coleman
authors.affiliation: Department of Neurology, University of Michigan, Ann Arbor, MI.
authors.forename: Vikas
authors.initials: V
authors.lastname: Kotagal
authors.affiliation: Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, MI ; Department of Neurosurgery, University of Michigan, Ann Arbor, MI.
authors.forename: Parag G
authors.initials: PG
authors.lastname: Patil
authors.affiliation: Department of Neurology, University of Michigan, Ann Arbor, MI ; Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, MI ; Department of Neurosurgery, University of Michigan, Ann Arbor, MI.
authors.forename: Kelvin L
authors.initials: KL
authors.lastname: Chou
keywords: Parkinson disease; appropriateness; deep brain stimulation; referrals; screening tools