Am I a Candidate for Deep Brain Stimulation
and What are the Ten Questions I Need to Ask About DBS?
By University of Florida Physicians Michael S. Okun, M.D., Hubert H. Fernandez, M.D., and Kelly D. Foote, M.D.
# 5 – Should Patients See a Movement Disorders Neurologist for Medical Optimization Prior to Surgery?
If there was ever a trip that was worth making, seeing the movement disorders neurologist prior to DBS implantation may be the most valuable use of time and resources an individual patient and family can make. Accurate diagnosis, medical optimization, and discussion of a plan of care, particularly for chronic progressive diseases like PD, will lay the foundation for future successes, whether medical or surgical. Also, it should be understood that in most cases surgery will not alleviate the need for medications and continuing medical management (another myth propagated by media and internet sources).
The majority of patients we see in our movement disorders neurology practice, after careful assessment have an unfavorable risk to benefit ratio for surgery at least at the initial assessment. This ratio may of course improve with optimization of therapy. Of the group of reasonable surgical candidates, as many as 20-25% will decide either not to have surgery or to delay surgery because of successful medical optimization.
Movement disorders neurologists have the important task of making the careful determination that an individual patient is medically refractory, and often will need to evaluate patients on standardized scales on and off medication. If this task is difficult and time consuming for a movement disorders neurologist, you can imagine how difficult it may be for the general neurologist or practitioner. Although there are many skilled and licensed health care providers, in general there is no substitute for the training of a movement disorders neurologist when considering such an important decision. The other advantage of the movement disorders neurologist is the time devoted to determining, especially in PD patients, which symptoms will respond to therapy and which symptoms will not. This is crucial for each individual patient (for example the patient who wants his or her balance back from the surgery; but after evaluation the movement disorders neurologist he or she learns the balance symptom is unlikely to improve following surgery).