title: Underutilization of deep brain stimulation for Parkinson's disease? A survey on possible clinical reasons.
abstract: Only 10% of the up to 15% of patients with advanced Parkinson's disease (PD) eligible for deep brain stimulation (DBS) are referred to specialized centers. This survey evaluated the reasons for the reluctance of patients and referring physicians regarding DBS.
  
  
  
  Two different questionnaires containing multiple choice and open verbalized questions were developed, one for neurologists and one for patients with PD. The first questionnaire was sent to 87 neurologists in private practice in the catchment area of the authors' medical center, the second to patient support groups in the same region with the help of the German Parkinson Association.
  
  
  
  Of the addressed neurologists, 56.3% completed the questionnaire; 61.2% of them estimated the risk of intracerebral hemorrhage as the most severe complication at 4.3% on average; 30.6% were concerned about patients developing mood changes or depression after DBS. Only 16.3% felt unable to care for patients after DBS; 61.2% already had personal experience with patients after DBS and reported good clinical outcome in 90.0% of patients. Although 87.8% claimed to know the specific criteria for DBS, only 40.8% could actively describe them. Only 14.0% could state each of the three main criteria. Of the 46 patients, 88.1% completing the questionnaire had obtained information on DBS from regional patient organizations and 54.8% also from a physician; 44.7% assumed the risk of severe complications to be ≥5.0%. Not being satisfied with their medical treatment was reported by 22.2%, of whom more than 70% considered DBS a further treatment option.
  
  
  
  The latter numbers indicate that treating neurologists tend to overestimate the reluctance of their patients to undergo DBS. Therefore, education of patients and neurologists should be improved and give more realistic figures on the actual outcomes and frequencies of possible complications.
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany. max.lange@ukr.de.|Center for Deep Brain Stimulation, University Medical Center Regensburg, Regensburg, Germany. max.lange@ukr.de.
authors.forename: Max
authors.initials: M
authors.lastname: Lange
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Mauerer
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.|Center for Deep Brain Stimulation, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Schlaier
authors.affiliation: Center for Deep Brain Stimulation, University Medical Center Regensburg, Regensburg, Germany.|Department of Neurology, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Janzen
authors.affiliation: Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Zeman
authors.affiliation: Department of Neurology, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Bogdahn
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Brawanski
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hochreiter
mesh_terms: D046690:Deep Brain Stimulation / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D000072141:Neurologists / Q000706:statistics & numerical data*; D010300:Parkinson Disease / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*
keywords: Awareness; Deep brain stimulation; Parkinson’s disease; Patient selection; Underutilization