A decision tool to support appropriate referral for deep brain stimulation in Parkinson's disease
Identifieur interne : 002120 ( Main/Exploration ); précédent : 002119; suivant : 002121A decision tool to support appropriate referral for deep brain stimulation in Parkinson's disease
Auteurs : Elena Moro [Canada] ; Niels Allert [Allemagne] ; Roberto Eleopra [Italie] ; Jean-Luc Houeto [France] ; Tra-Mi Phan [Suisse] ; Herman Stoevelaar [Belgique]Source :
- Journal of neurology [ 0340-5354 ] ; 2009.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Décision.
English descriptors
Abstract
Background and objective Although Deep Brain Stimulation (DBS) has been proven to be an effective treatment for patients with advanced Parkinson's disease (PD), it may be difficult for general neurologists to identify appropriate candidates for this procedure. We developed an electronic decision tool that can assist neurologists in deciding which PD patients should be referred for DBS consideration. Methods Using the RAND/UCLA Appropriateness Method, an international expert panel assessed the appropriateness of referral for 972 theoretical patient profiles. Panel results were embedded in an electronic decision support tool which displays the panel statement on referral (appropriate, inappropriate and uncertain) after completion of the patient profile. Results Referral was considered appropriate for 33 % of the theoretical profiles. Logistic regression showed excellent internal consistency of the ratings (predictive value 92%). Symptom severity (OFF-symptoms, dyskinesias, refractory tremor) and PD duration were positively associated with the panel judgment that referral is appropriate. Presence of levodopa-resistant axial symptoms, age ≥ 70 years and presence of cognitive impairment showed the strongest negative impact. Conclusions The RAND/UCLA method proved to be useful in determining the appropriate criteria for DBS referral. Validity and applicability of the decision tool (accessible via http://test.stimulus-dbs.org) in clinical practice need to be further determined.
Affiliations:
- Allemagne, Belgique, Canada, France, Italie, Suisse
- District de Cologne, Ontario, Rhénanie-du-Nord-Westphalie
- Bonn, Toronto
- Université de Toronto
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- to stream PascalFrancis, to step Corpus: 000574
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Le document en format XML
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<term>Pathologie du système nerveux</term>
<term>Décision</term>
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<front><div type="abstract" xml:lang="en">Background and objective Although Deep Brain Stimulation (DBS) has been proven to be an effective treatment for patients with advanced Parkinson's disease (PD), it may be difficult for general neurologists to identify appropriate candidates for this procedure. We developed an electronic decision tool that can assist neurologists in deciding which PD patients should be referred for DBS consideration. Methods Using the RAND/UCLA Appropriateness Method, an international expert panel assessed the appropriateness of referral for 972 theoretical patient profiles. Panel results were embedded in an electronic decision support tool which displays the panel statement on referral (appropriate, inappropriate and uncertain) after completion of the patient profile. Results Referral was considered appropriate for 33 % of the theoretical profiles. Logistic regression showed excellent internal consistency of the ratings (predictive value 92%). Symptom severity (OFF-symptoms, dyskinesias, refractory tremor) and PD duration were positively associated with the panel judgment that referral is appropriate. Presence of levodopa-resistant axial symptoms, age ≥ 70 years and presence of cognitive impairment showed the strongest negative impact. Conclusions The RAND/UCLA method proved to be useful in determining the appropriate criteria for DBS referral. Validity and applicability of the decision tool (accessible via http://test.stimulus-dbs.org) in clinical practice need to be further determined.</div>
</front>
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