title: A suggested minimum standard deep brain stimulation evaluation for essential tremor.
abstract: BACKGROUND
  A comprehensive, multidisciplinary screening process for deep brain stimulation (DBS) candidates is recommended, but is often time-consuming.
  
  
  OBJECTIVE
  To determine the number of essential tremor (ET) referrals excluded from surgery and why, in order to develop recommendations for a minimum standard DBS evaluation process.
  
  
  METHODS
  We reviewed the referrals of 100 consecutive potential DBS candidates with presumed ET at our center, identified reasons for excluding patients from DBS, and the point at which they dropped out of our evaluation process.
  
  
  RESULTS
  Of the 100 tremor patients referred for DBS, 36 patients were approved for surgery. Patients were mainly excluded because of the movement disorders neurologist and neuropsychologist evaluations. Reasons included an inadequate medication trial (n=20), incorrect diagnosis (n=3), dementia (n=3), and antagonistic interactions with the team (n=1). 37 patients did not present, were uninterested or lost to follow-up. Neither neurosurgical evaluation nor brain imaging excluded candidates in this study, but are needed to proceed with DBS.
  
  
  CONCLUSIONS
  Our suggested minimum standard DBS screening process begins with a movement disorders neurologist and neuropsychologist evaluation in order to determine eligibility. Neurosurgical evaluation and brain imaging can then be performed if candidates are deemed eligible.
authors.affiliation: Michigan State University Medical School, East Lansing, MI, United States.
authors.forename: Neha
authors.initials: N
authors.lastname: Shah
authors.affiliation: Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, MI, United States; Department of Neurology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Leventhal
authors.affiliation: Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, MI, United States; Department of Psychiatry, Division of Neuropsychology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Carol
authors.initials: C
authors.lastname: Persad
authors.affiliation: Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, MI, United States; Department of Neurology, University of Michigan, Ann Arbor, MI, United States; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Parag G
authors.initials: PG
authors.lastname: Patil
authors.affiliation: Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, MI, United States; Department of Neurology, University of Michigan, Ann Arbor, MI, United States; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States. Electronic address: klchou@med.umich.edu.
authors.forename: Kelvin L
authors.initials: KL
authors.lastname: Chou
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods* / Q000592:standards*; D004185:Disability Evaluation; D020329:Essential Tremor / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Deep brain stimulation; Essential tremor; Multidisciplinary evaluation; Referrals