Neurosurgeons perspective on the shift towards earlier use of deep brain stimulation for Parkinson disease

Background: The US Food and Drug Administration approved in 2015 the use of deep brain stimulation for Parkinson disease after “four years duration and with recent onset of motor complications”. The aim of this study was to identify neurosurgeons’ attitudes and perspectives around the use of deep brain stimulation for Parkinson disease earlier in the disease course. Methods: An anonymous survey examining attitudes and perceptions towards deep brain stimulation practice and timing in Parkinson disease was developed by the study team and distributed by the American Society for Stereotactic and Functional Neurosurgeons to its members. Results from 32 subjects with answers to at least 50% of the survey were included. Data were analyzed with descriptive statistics and chi-square test. Results: Motor fluctuations, dyskinesia, quality of life impairment, and medically refractory tremor were the most important reasons to proceed with deep brain stimulation, which was overall considered more useful after the onset of motor symptoms. Unresponsiveness to levodopa, cognitive impairment, and unclear diagnosis were important reasons not to consider deep brain stimulation. Earlier surgery was considered to be less risky compared to later in the disease progression. Ten out of 25 neurosurgeons reported considering deep brain stimulation as a therapeutic option after a minimum disease duration of three to four years. Conclusions: We conclude that neurosurgeons support the use of earlier deep brain stimulation, but not preceding motor complications. Further research surrounding the benefits and adverse effects of earlier deep brain stimulation is needed to guide practice and better inform potential candidates.