title: Patients' reluctance to undergo deep brain stimulation for Parkinson's disease.
abstract: BACKGROUND
  Many patients with advanced Parkinson's disease (PD) are reluctant to undergo the subthalamic nucleus deep brain stimulation (STN-DBS) when surgery is warranted. Reasons for this reluctance have not been examined. We undertook to establish the rate and causes of this reluctance for STN-DBS in patients with advanced PD.
  
  
  METHODS
  A reluctant group was defined as patients who were hesitant to undergo DBS. Clinical information included age, onset age, disease duration, the Unified Parkinson Disease Rating Scale, Hoehn and Yahr stage and levodopa equivalent dose when they were evaluated with a view to consider surgery.
  
  
  RESULTS
  We enrolled 186 patients who underwent STN-DBS. 84 patients (45%) belonged to the reluctant group. Between the reluctant and the non-reluctant, there were no differences in preoperative characteristics. Main reasons for hesitation were fear of complications (74%) and economic burden (50%). The main reasons that they finally underwent the DBS were confidence in the doctor's decision (80%) and encouragement from their family (36%).
  
  
  CONCLUSIONS
  Building trust between patients and physicians is an important factor in guiding patients to undergo this treatment. To reduce the reluctance to undergo DBS at the appropriate time, we need to find effective ways of reducing their psychological and economic burden.
authors.affiliation: Department of Neurosurgery, Movement Disorder Center and Neuroscience Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Mi-Ryoung
authors.initials: MR
authors.lastname: Kim
authors.affiliation: Department of Neurology, Ewha Womans University Mokdong Hospital and Ewha Womans University School of Medicine, Seoul, Republic of Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Yun
authors.affiliation: Department of Neurology, Movement Disorder Center and Neuroscience Research Institute, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: brain@snu.ac.kr.
authors.forename: Beomseok
authors.initials: B
authors.lastname: Jeon
authors.affiliation: Department of Neurosurgery, Movement Disorder Center and Neuroscience Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Yong Hoon
authors.initials: YH
authors.lastname: Lim
authors.affiliation: Department of Neurosurgery, Movement Disorder Center and Neuroscience Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Kyung Ran
authors.initials: KR
authors.lastname: Kim
authors.affiliation: Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
authors.forename: Hui-Jun
authors.initials: HJ
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, Movement Disorder Center and Neuroscience Research Institute, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: paeksh@snu.ac.kr.
authors.forename: Sun Ha
authors.initials: SH
authors.lastname: Paek
mesh_terms: D000328:Adult; D000368:Aged; D017281:Cost of Illness; D046690:Deep Brain Stimulation / Q000191:economics; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data
keywords: Deep brain stimulation; Motor control; Parkinson's disease