Referring patients for deep brain stimulation: An improving practice

Background: Deep brain stimulation (DBS) is a recent treatment modality. Few studies have examined referral practices for DBS. Objective: To review referral patterns to a large movement disorders center to investigate the current level of knowledge surrounding DBS candidacy. Design: Retrospective analysis. Setting: Tertiary care medical center. Patients: Reviewed were 197 medical records of patients referred for DBS between December 1, 2005, and November 30, 2009. Main Outcome Measures: Standardized criteria for DBS patient selection were used to categorize referred DBS candidates as the following: good candidates, possible future candidates, poor candidates because of neurological contraindications, or poor candidates because of medical contraindications. Yearly percentages were computed. Referral sources were categorized as movement disorder specialists vs non-movement disorder physicians and self-referred. Results: In total, 165 referrals (83.8%) had ailments for which DBS was indicated, and 100 referrals (50.8%) were good candidates (62 with idiopathic Parkinson disease, 35 with dystonia, and 3 with essential tremor). Referrals by movement disorder specialists vs other sources differed significantly in their percentages of good candidates (66.7% vs 40.4%, P=.002) and possible future candidates (14.7% vs 32.7%, P=.02) but not poor candidates (18.7% vs 25.0%, P=.60). Over the observed period of referrals, the yearly percentages significantly decreased for good candidates and increased for possible future candidates and poor candidates. Conclusions: Compared with findings in prior studies, the quality of DBS referrals has improved. The increase in referral of possible future candidates and poor candidates may reflect greater confidence in the procedure.