Randomized controlled studies have shown deep brain stimulation (DBS) to be an effective treatment for Parkinson's disease (PD). Outside of large-center studies, little is known about trends in DBS use in the USA.
We employ the Nationwide Inpatient Sample to look at changes in DBS utilization over time.
We identified all individuals with PD (332.0) and essential tremor (ET) (333.1) who underwent DBS (02.93) from 1998 to 2007. We examined demographics, hospital status, comorbidities, and in-hospital systemic/technical complications. DBS patients from 2000 and 2007 were compared using χ(2) tests.
PD patients from the 2007 sample who underwent DBS were older (p = 0.01). Both ET and PD patients had significantly more comorbidities in 2007 (p < 0.001). In-hospital complications decreased from 3.8 to 2.8%. DBS was performed in medium- or high-volume centers in 70% of cases in 2000 and in 50% in 2007. In all groups, a majority of cases (range 65-71%) underwent DBS at hospitals in the western and southern USA.
Patients who underwent DBS in the 2007 sample were older and had more comorbidities than those in the 2000 sample; in-hospital complications remained low. Understanding trends in DBS is helpful in assessing how the technology is adopted and what relationships should be further explored.
[Show abstract][Hide abstract] ABSTRACT: Deep brain stimulation (DBS) has become a standard therapy for some forms of severe movement disorders and is investigated for other neurological and psychiatric disorders, although many scientific, clinical and ethical issues are still open. We analyse how the Swiss DBS community addresses these problematic issues and future challenges.
We have performed a survey among Swiss DBS centres and a Delphi study with representatives of all centres and further stakeholders related to the topic.
The current DBS infrastructure in Switzerland consists of seven facilities. About 850-1,050 patients have received a DBS system in Switzerland for various indications since its advent in 1976. Critical issues like patient selection and dealing with side effects are in accordance with international standards. There are indications of a conservative referral practice in Switzerland for DBS interventions, but the data available do not allow verifying or refuting this point.
Issues to investigate further are whether or not there is an unmet medical need with respect to DBS, long-term medical and psychosocial sequelae of the intervention, conditions for enhancing the (research) collaboration of Swiss DBS centers, and the effect of the recent decision to reduce the number of DBS centres to 4 (resp. possibly 3) on the potential of this therapeutic approach.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Tardive dyskinesia and dystonia (TDD) are severe side effects of dopamine-blocking agents, particularly antipsychotics. While deep brain stimulation (DBS) has proven effective in the treatment of TDD, little is known about the possible psychiatric complications of DBS in psychiatric patients. OBJECTIVE: To assess the efficacy and safety, specifically the psychiatric side effects, of DBS in patients with medication-induced TDD. DATA SOURCES: PubMed and EMBASE databases were searched systematically on May 25, 2011, for articles written in English, using the search terms deep brain stimulation AND tardive. STUDY SELECTION: Of the 88 original articles retrieved, 17 studies involving 50 patients with TDD who underwent DBS were included in the review. DATA EXTRACTION: Data on the severity of the movement disorders before and after DBS, as rated on the Burke-Fahn-Marsden Dystonia Rating Scale or similar scales, were extracted. Data on psychiatric symptoms before and after DBS were used to calculate the percent improvement per patient per rating scale. Overall improvement and confidence intervals were calculated using a 1-sample, 2-sided Student t test. RESULTS: The mean improvement of TDD of the combined patients 3 to 76 months after implantation was 77.5% (95% CI, 71.4%-83.3%; P < .000) on the Burke-Fahn-Marsden Dystonia Rating Scale. Of the 50 patients, 1 experienced an exacerbation of depression, and 1 experienced an exacerbation of psychosis. CONCLUSIONS: DBS seems to be effective and relatively safe for patients with treatment-resistant TDD; however, the results should be interpreted with caution, as most of the data are from case reports and small trials.
The Journal of Clinical Psychiatry 11/2012; 73(11):1434-1438. DOI:10.4088/JCP.12r07643 · 5.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article focuses on the evolution of deep brain stimulation (DBS) targets within the brain, beginning with the discovery of DBS's potential in non-Parkinson disease movement disorders. DBS has gained in popularity and applicability for a growing number of neuropathologic conditions with neural network disorders and dysfunction. Targets within the brain have been based frequently on historical sites used for ablative surgeries in years past, derived from experiment and experience but also have arisen via elucidation of neural networks, transmitter function and location, disease neuropathology, and also, fortuitous discovery.
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