title: Referring Parkinson's disease patients for deep brain stimulation: a RAND/UCLA appropriateness study.
abstract: 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.
authors.affiliation: Division of Neurology, CHU of Grenoble, Joseph Fourier University, INSERM U836, Grenoble, France.
authors.forename: Elena
authors.initials: E
authors.lastname: Moro
authors.affiliation: Department of Neurology, Movement Disorders Center, Bern University Hospital and University of Bern, Bern, Switzerland.|Assistance-Publique Hôpitaux de Paris; Centre d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière; Département de Neurologie, Université Pierre et Marie Curie, Paris 6 et INSERM, CHU Pitié-Salpêtrière, Paris, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Schüpbach
authors.affiliation: Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.|Center of Rehabilitation, Bad Gögging, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Wächter
authors.affiliation: Neurological Rehabilitation Center Godeshoehe, Bonn, Germany.
authors.forename: Niels
authors.initials: N
authors.lastname: Allert
authors.affiliation: Department of Neurology, Santa Maria della Misericordia University Hospital, Udine, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Eleopra
authors.affiliation: Division of Neurosurgery, University of British Columbia, Vancouver, Canada.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Honey
authors.affiliation: Departamento de Neurociencias, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Rueda
authors.affiliation: Department of Neurology, University of Texas Medical School at Houston, Texas, USA.
authors.forename: Mya C
authors.initials: MC
authors.lastname: Schiess
authors.affiliation: Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shimo
authors.affiliation: 2nd Department of Neurology, Comenius University Faculty of Medicine and University Hospital Bratislava, Bratislava, Slovakia.
authors.forename: Peter
authors.initials: P
authors.lastname: Valkovic
authors.affiliation: Department of Neurology, Frenchay Hospital, Bristol, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Whone
authors.affiliation: Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium. herman.stoevelaar@ismar.com.
authors.forename: Herman
authors.initials: H
authors.lastname: Stoevelaar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis* / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards*; D012720:Severity of Illness Index
keywords: Consultation; Deep brain stimulation; Parkinson’s disease; RAND/UCLA appropriateness method; Referral