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Vol. 90, No. 1, 2012
Issue release date: February 2012
Section title: Clinical Study
Stereotact Funct Neurosurg 2012;90:25–29
(DOI:10.1159/000333834)

Changing Practice Patterns of Deep Brain Stimulation in Parkinson’s Disease and Essential Tremor in the USA

Pilitsis J.G. · Burrows A. · Linton Peters M. · Sargent J. · Ng S.C. · Tseng J.F.
aDivision of Neurosurgery, Albany Medical College, Albany, N.Y., and bDivision of Neurosurgery, and cSurgical Outcomes Analysis and Research (SOAR), Department of Surgery, University of Massachusetts Medical School, Worcester, Mass., USA

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Article / Publication Details

First-Page Preview
Abstract of Clinical Study

Received: 6/9/2011 5:45:58 PM
Accepted: 9/28/2011
Published online: 12/22/2011

Number of Print Pages: 5
Number of Figures: 2
Number of Tables: 3

ISSN: 1011-6125 (Print)
eISSN: 1423-0372 (Online)

For additional information: http://www.karger.com/SFN

Abstract

Background: 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. Objectives: We employ the Nationwide Inpatient Sample to look at changes in DBS utilization over time. Methods: 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 χ2 tests. Results: 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. Conclusions: 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.


Article / Publication Details

First-Page Preview
Abstract of Clinical Study

Received: 6/9/2011 5:45:58 PM
Accepted: 9/28/2011
Published online: 12/22/2011

Number of Print Pages: 5
Number of Figures: 2
Number of Tables: 3

ISSN: 1011-6125 (Print)
eISSN: 1423-0372 (Online)

For additional information: http://www.karger.com/SFN


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Pahwa R, Lyons KE, Wilkinson SB, Tröster AI, Overman J, Kieltyka J, Koller WC: Comparison of thalamotomy to deep brain stimulation of the thalamus in essential tremor. Mov Disord 2001;16:140–143.
  2. Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schäfer H, Bötzel K, Daniels C, Deutschländer A, Dillmann U, Eisner W, Gruber D, Hamel W, Herzog J, Hilker R, Klebe S, Kloss M, Koy J, Krause M, Kupsch A, Lorenz D, Lorenzl S, Mehdorn HM, Moringlane JR, Oertel W, Pinsker MO, Reichmann H, Reuss A, Schneider GH, Schnitzler A, Steude U, Sturm V, Timmermann L, Tronnier V, Trottenberg T, Wojtecki L, Wolf E, Poewe W, Voges J, German Parkinson Study Group, Neurostimulation Section: A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 2006;355:896–908.
  3. Weaver FM, Follett K, Stern M, Hur K, Harris C, Marks WJ Jr, Rothlind J, Sagher O, Reda D, Moy CS, Pahwa R, Burchiel K, Hogarth P, Lai EC, Duda JE, Holloway K, Samii A, Horn S, Bronstein J, Stoner G, Heemskerk J, Huang GD, CSP 468 Study Group: Bilateral deep brain stimulation versus best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA 2009;301:63–73.
  4. Williams A, Gill S, Varma T, Jenkinson C, Quinn N, Mitchell R, Scott R, Ives N, Rick C, Daniels J, Patel S, Wheatley K, PD SURG Collaborative Group: Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson’s disease (PD SURG trial): a randomised, open-label trial. Lancet Neurol 2010;9:581–591.
  5. Koller WC, Lyons KE, Wilkinson SB, Troster AI, Pahwa R: Long-term safety and efficacy of unilateral deep brain stimulation of the thalamus in essential tremor. Mov Disord 2001;16:464–468.
  6. Agency for Healthcare Research and Quality: HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2007–2009. Agency for Healthcare Research and Quality, Rockville. www.hcup-us.ahrq.gov/nisoverview.jsp.
  7. Public Health Service, US Department of Health and Human Services:International Classifications of Diseases, Ninth Revision, Clinical Modification. Washington, Public Health Service, US Department of Health and Human Services, 1998.
  8. Elixhauser A, Steiner C, Harris DR, Coffey RM: Comorbidity measures for use with administrative data. Med Care 1998;36:8–27.
  9. Parent B, Awan N, Berman SB, Suski V, Moore R, Crammond D, Kondziolka D: The relevance of age and disease duration for intervention with subthalamic nucleus deep brain stimulation surgery in Parkinson disease. J Neurosurg 2011;114:927–931.
  10. Deuschl G, Fogel W, Hahne M, Kupsch A, Müller D, Oechsner M, Sommer U, Ulm G, Vogt T, Volkmann J: Deep-brain stimulation for Parkinson’s disease. J Neurol 2002;249(suppl 3):III/36–39.
  11. Schüpbach WM, Maltête D, Houeto JL, du Montcel ST, Mallet L, Welter ML, Gargiulo M, Béhar C, Bonnet AM, Czernecki V, Pidoux B, Navarro S, Dormont D, Cornu P, Agid Y: Neurosurgery at an earlier stage of Parkinson disease: a randomized, controlled trial. Neurology 2007;68:267–271.
  12. Lad SP, Kalanithi PS, Patil CG, Itthimathin P, Batya S, Bronte-Stewart H, Boakye M, Henderson JM: Socioeconomic trends in deep brain stimulation (DBS) surgery. Neuromodulation 2010;13:182–186.
  13. Rodgers EM: Diffusion of Innovation, ed 5. New York, Free Press, 2003.
  14. Moore GA: Crossing the Chasm, ed 1, revised. New York, Harper Collins, 1999.
  15. Benbadis SR, Heriaud L, Tatum WO, Vale FL: Epilepsy surgery, delays and referral patterns – are all your epilepsy patients controlled? Seizure 2003;12:167–170.
  16. de Flon P, Kumlien E, Reuterwall C, Mattsson P: Empirical evidence of underutilization of referrals for epilepsy surgery evaluation. Eur J Neurol 2010;17:619–625.
  17. Hakimi AS, Spanaki MV, Schuh LA, Smith BJ, Schultz L: A survey of neurologists’ views on epilepsy surgery and medically refractory epilepsy. Epilepsy Behav 2008;13:96–101.
  18. Kumlien E, Mattsson P: Attitudes towards epilepsy surgery: a nationwide survey among Swedish neurologists. Seizure 2010;19:253–255.
  19. http://www.pdtrials.org (accessed April 28, 2011).
  20. http://www.apdaparkinson.org/userND/advancedcenters.asp (accessed April 28, 2011).
  21. http://www.parkinson.org/Improving-Care/NPF-Network/NPF-s-Center-of-Excellence-Network-%281%29 (accessed April 28, 2011).
  22. http://www.wemove.org/ (accessed April 28, 2011).
  23. Parashos SA, Maraganore DM, O’Brien PC, Rocca WA: Medical services utilization and prognosis in Parkinson disease: a population-based study. Mayo Clin Proc 2002;77:918–925.
  24. http://www.aan.com/ (accessed April 29, 2011).
  25. Eskandar EN, Flaherty A, Cosgrove GR, Shinobu LA, Barker FG 2nd: Surgery for Parkinson disease in the United States, 1996 to 2000: practice patterns, short-term outcomes, and hospital charges in a nationwide sample. J Neurosurg 2003;99:863–871.
  26. Okun MS, Tagliati M, Pourfar M, Fernandez HH, Rodriguez RL, Alterman RL, Foote KD: Management of referred deep brain stimulation failures: a retrospective analysis from 2 movement disorders centers. Arch Neurol 2005;62:1250–1255.
  27. Ellis TM, Foote KD, Fernandez HH, Sudhyadhom A, Rodriguez RL, Zeilman P, Jacobson CE 4th, Okun MS: Reoperation for suboptimal outcomes after deep brain stimulation surgery. Neurosurgery 2008;63:754–760.
  28. Iezzoni L, Foley SM, Daley J, et al: Comorbidities, complications, and coding bias: does the number of diagnosis codes matter in predicting in-hospital mortality? JAMA 1992;267:2197–2203.
  29. Jencks SF, Williams DK, Kay TL: Assessing hospital-associated deaths from discharge data: the role of length of stay and comorbidities. JAMA 1988;260:2240–2246.