title: Establishing a Standard of Care for Deep Brain Stimulation Centers in Canada.
abstract: During the "DBS Canada Day" symposium held in Toronto July 4-5, 2014, the scientific committee invited experts to share their knowledge regarding deep brain stimulation (DBS) management of movement disorders in three domains: (1) the programming algorithms, (2) the necessary team to run a neurosurgery program, and (3) the appropriate scales to better define in a more comprehensive fashion the effect of the brain surgery. Each presentation was followed by an open discussion, and this article reports on the conclusions of this meeting on these three questions. Concerning programming, the role of the pulse width and the switching off of the stimulation at night for thalamic stimulation for the control of tremor have been discussed. The algorithms proposed in the literature for programming in Parkinson's disease (PD) need validation. In dystonia, the use of monopolar vs bipolar parameters, the use of low vs high frequencies and the use of smaller versus larger pulse widths all need to be examined properly. Concerning the necessary team to run a neurosurgical program, recommendations will follow the suggestions for standardized outcome measures. Regarding the outcome measures for DBS in PD, investigations need to focus on the non-motor aspects of PD. Identifying which nonmotor symptoms respond to DBS would allow a better screening before and satisfaction postoperatively. There is an important need for more data to determine the optimal programming protocol and the standard measures that should be performed routinely by all centers.
authors.affiliation: 1Division of Neurology,Department of Medicine,Hôpital Notre-Dame,Centre hospitalier de l'Université de Montréal,Montréal,Québec,Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Panisset
authors.affiliation: 2Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease,Toronto Western Hospital,University Health Network,Toronto,ON,Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Picillo
authors.affiliation: 1Division of Neurology,Department of Medicine,Hôpital Notre-Dame,Centre hospitalier de l'Université de Montréal,Montréal,Québec,Canada.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jodoin
authors.affiliation: 2Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease,Toronto Western Hospital,University Health Network,Toronto,ON,Canada.
authors.forename: Yu-Yan
authors.initials: YY
authors.lastname: Poon
authors.affiliation: 2Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease,Toronto Western Hospital,University Health Network,Toronto,ON,Canada.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Valencia-Mizrachi
authors.affiliation: 2Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease,Toronto Western Hospital,University Health Network,Toronto,ON,Canada.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fasano
authors.affiliation: 2Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease,Toronto Western Hospital,University Health Network,Toronto,ON,Canada.
authors.forename: Renato
authors.initials: R
authors.lastname: Munhoz
authors.affiliation: 4Division of Neurosurgery,University of British Columbia,Vancouver,British Columbia,Canada.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Honey
mesh_terms: D002170:Canada; D046690:Deep Brain Stimulation / Q000592:standards*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000592:standards*; D010300:Parkinson Disease / Q000628:therapy*; D059039:Standard of Care / Q000592:standards*
keywords: Parkinson’s disease; dystonia; deep brain stimulation; essential tremor; programming; tremor