Parkinson's disease patient preference and experience with various methods of DBS lead placement

• Published in: Parkinsonism & related disorders Vol. 41; pp. 25 - 30
• Main Authors: LaHue, Sara C., Ostrem, Jill L., Galifianakis, Nicholas B., San Luciano, Marta, Ziman, Nathan, Wang, Sarah, Racine, Caroline A., Starr, Philip A., Larson, Paul S., Katz, Maya
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2017
• Subjects: Aged; Deep Brain Stimulation - methods; Deep brain stimulation surgery; Electrodes, Implanted; Female; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Neurology; Parkinson Disease - diagnostic imaging; Parkinson Disease - psychology; Parkinson Disease - therapy; Parkinson's disease; Patient Preference - psychology; Patient satisfaction; Retrospective Studies; Treatment Outcome; Deep brain stimulation surgery; Parkinson's disease; Patient satisfaction
• ISSN: 1353-8020; 1873-5126; 1873-5126
• DOI: 10.1016/j.parkreldis.2017.04.010

Physiology-guided deep brain stimulation (DBS) surgery requires patients to be awake during a portion of the procedure, which may be poorly tolerated. Interventional MRI-guided (iMRI) DBS surgery was developed to use real-time image guidance, obviating the need for patients to be awake during lead placement. All English-speaking adults with PD who underwent iMRI DBS between 2010 and 2014 at our Center were invited to participate. Subjects completed a structured interview that explored perioperative preferences and experiences. We compared these responses to patients who underwent the physiology-guided method, matched for age and gender. Eighty-nine people with PD completed the study. Of those, 40 underwent iMRI, 44 underwent physiology-guided implantation, and five underwent both methods. There were no significant differences in baseline characteristics between groups. The primary reason for choosing iMRI DBS was a preference to be asleep during implantation due to: 1) a history of claustrophobia; 2) concerns about the potential for discomfort during the awake physiology-guided procedure in those with an underlying pain syndrome or severe off-medication symptoms; or 3) non-specific fear about being awake during neurosurgery. Participants were satisfied with both DBS surgery methods. However, identification of the factors associated with a preference for iMRI DBS may allow for optimization of patient experience and satisfaction when choices of surgical methods for DBS implantation are available. •The primary reason for choosing iMRI-guided DBS was a preference to be under general anesthesia during neurosurgery.•Reasons to prefer being under general anesthesia included 1) a history of claustrophobia; 2) concerns about potential discomfort during an awake neurosurgical procedure in those with chronic pain or severe off-medication symptoms; or 3) non-specific fear about being awake during neurosurgery.•Approximately a quarter of participants who underwent awake physiology-guided DBS surgery reported pain during the procedure.•Satisfaction was high for both surgical implantation techniques, as well as for deep brain stimulation therapy as a whole.