Analysing the reasons for rejection of neurosurgery intervention in patients with Parkinson’s disease referred to an extrapyramidal movement disorders clinic

We present findings of a 10-year retrospective study, analysing the reasons for rejection of neurosurgical intervention (deep brain stimulation or DBS) in patients with Parkinsons disease, who were referred to an extrapyramidal movement disorders clinic and then to a neurosurgery centre. It was found that after screening, 78.6% of patients referred as candidates for neurosurgical treatment to an extrapyramidal movement disorders clinic were rejected, while 21.4% of patients were referred to a neurosurgery centre, where 12% underwent surgery. The main reasons for rejecting potential DBS candidates were: early referral, inadequate pharmacotherapy, levodopa-resistant symptoms, atypical/secondary Parkinsonism, cognitive reasons, psychological reasons, comorbidity, abnormal MRI, poor response to levodopa medication and declined surgery. Furthermore, the number of self-referrals decreased, the number of patients referred by neurologists increased, the number of rejections of unsuitable DBS candidates decreased, and the number of suitable candidates referred to the extrapyramidal centre increased during the time period of 10 years. In addition, the number of patients who were referred to the neurosurgery centre and underwent surgery there increased, which suggests greater awareness of the selection criteria among doctors, as well increased knowledge and experience among neurologists in both primary healthcare and specialized centres.

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Deep brain stimulation for the treatment of cerebral palsy: A review

Brain Science Advances ◽

10.26599/bsa.2020.9050002 ◽

2020 ◽

Vol 6 (1) ◽

pp. 20-29

Author(s):

Hongjie Jiang ◽

Rui Wang ◽

Zhe Zheng ◽

Junming Zhu

Keyword(s):

Cerebral Palsy ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Movement Disorders ◽

Motor Impairment ◽

Mechanisms Of Action ◽

Medical Interventions ◽

Number Of Patients ◽

Presurgical Assessment ◽

Deep Brain

Deep brain stimulation (DBS) has been used as a safe and effective neuromodulation technique for treatment of various diseases. A large number of patients suffering from movement disorders such as dyskinesia may benefit from DBS. Cerebral palsy (CP) is a group of permanent disorders mainly involving motor impairment, and medical interventions are usually unsatisfactory or temporarily active, especially for dyskinetic CP. DBS may be another approach to the treatment of CP. In this review we discuss the targets for DBS and the mechanisms of action for the treatment of CP, and focus on presurgical assessment, efficacy for dystonia and other symptoms, safety, and risks.

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Deep brain stimulation: practical insights and common queries

Practical Neurology ◽

10.1136/practneurol-2019-002275 ◽

2019 ◽

Vol 19 (6) ◽

pp. 502-507 ◽

Cited By ~ 1

Author(s):

Fahd Baig ◽

Thomas Robb ◽

Lucy Mooney ◽

Caroline Robbins ◽

Caroline Norris ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Clinical Application ◽

Brain Stimulation ◽

Movement Disorders ◽

Secondary Care ◽

Number Of Patients ◽

Device Manufacturer ◽

Deep Brain

The number of patients with deep brain stimulation (DBS) devices implanted is increasing. Although practices vary between centres, patients are typically given training and information from their DBS nurse or clinician, as well as a comprehensive device manual and contact details for their device manufacturer. However, for the lifetime of a patient with a DBS system, most of their secondary care often occurs in a centre without a co-located DBS service. The local neurologist is often asked pragmatic questions regarding the do’s and don’ts for patients with DBS systems. While a DBS centre or device manufacturer can provide advice, we thought that it will be helpful to outline the overall management of DBS for movement disorders and the approach to commonly raised questions. We describe briefly the clinical application of DBS and discuss common scenarios where there are possible compatibility issues around the device.

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Patient Selection Criteria for Deep Brain Stimulation in Movement Disorders

Youmans Neurological Surgery ◽

10.1016/b978-1-4160-5316-3.00078-2 ◽

2011 ◽

pp. 914-922

Author(s):

Ioannis U. Isaias ◽

Michele Tagliati

Keyword(s):

Deep Brain Stimulation ◽

Patient Selection ◽

Brain Stimulation ◽

Movement Disorders ◽

Selection Criteria ◽

Patient Selection Criteria ◽

Deep Brain

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The Effect of Deep Brain Stimulation for Movement Disorders on Emotions

PsycEXTRA Dataset ◽

10.1037/e626972012-165 ◽

2008 ◽

Author(s):

Jonathan D. Richards ◽

Paul M. Wilson ◽

Pennie S. Seibert ◽

Carin M. Patterson ◽

Caitlin C. Otto ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Movement Disorders ◽

Deep Brain

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Reoperation for device infection and erosion following deep brain stimulation implantable pulse generator placement

Journal of Neurosurgery ◽

10.3171/2019.3.jns183023 ◽

2020 ◽

Vol 133 (2) ◽

pp. 403-410 ◽

Cited By ~ 1

Author(s):

Travis J. Atchley ◽

Nicholas M. B. Laskay ◽

Brandon A. Sherrod ◽

A. K. M. Fazlur Rahman ◽

Harrison C. Walker ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Movement Disorders ◽

Pulse Generator ◽

Rank Test ◽

Implantable Pulse Generator ◽

Device Infection ◽

Deep Brain

OBJECTIVEInfection and erosion following implantable pulse generator (IPG) placement are associated with morbidity and cost for patients with deep brain stimulation (DBS) systems. Here, the authors provide a detailed characterization of infection and erosion events in a large cohort that underwent DBS surgery for movement disorders.METHODSThe authors retrospectively reviewed consecutive IPG placements and replacements in patients who had undergone DBS surgery for movement disorders at the University of Alabama at Birmingham between 2013 and 2016. IPG procedures occurring before 2013 in these patients were also captured. Descriptive statistics, survival analyses, and logistic regression were performed using generalized linear mixed effects models to examine risk factors for the primary outcomes of interest: infection within 1 year or erosion within 2 years of IPG placement.RESULTSIn the study period, 384 patients underwent a total of 995 IPG procedures (46.4% were initial placements) and had a median follow-up of 2.9 years. Reoperation for infection occurred after 27 procedures (2.7%) in 21 patients (5.5%). No difference in the infection rate was observed for initial placement versus replacement (p = 0.838). Reoperation for erosion occurred after 16 procedures (1.6%) in 15 patients (3.9%). Median time to reoperation for infection and erosion was 51 days (IQR 24–129 days) and 149 days (IQR 112–285 days), respectively. Four patients with infection (19.0%) developed a second infection requiring a same-side reoperation, two of whom developed a third infection. Intraoperative vancomycin powder was used in 158 cases (15.9%) and did not decrease the infection risk (infected: 3.2% with vancomycin vs 2.6% without, p = 0.922, log-rank test). On logistic regression, a previous infection increased the risk for infection (OR 35.0, 95% CI 7.9–156.2, p < 0.0001) and a lower patient BMI was a risk factor for erosion (BMI ≤ 24 kg/m2: OR 3.1, 95% CI 1.1–8.6, p = 0.03).CONCLUSIONSIPG-related infection and erosion following DBS surgery are uncommon but clinically significant events. Their respective timelines and risk factors suggest different etiologies and thus different potential corrective procedures.

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The ENT emergency clinic: does senior input matter?

The Journal of Laryngology & Otology ◽

10.1017/s0022215112002538 ◽

2012 ◽

Vol 127 (1) ◽

pp. 15-19 ◽

Cited By ~ 5

Author(s):

A Mirza ◽

L McClelland ◽

M Daniel ◽

N Jones

Keyword(s):

Quality Of Care ◽

Discharge Rate ◽

Surrogate Marker ◽

Operating Theatre ◽

Number Of Children ◽

Discharge Rates ◽

Time Period ◽

Number Of Patients

AbstractBackground:Many ENT conditions can be treated in the emergency clinic on an ambulatory basis. Our clinic traditionally had been run by foundation year two and specialty trainee doctors (period one). However, with perceived increasing inexperience, a dedicated registrar was assigned to support the clinic (period two). This study compared admission and discharge rates for periods one and two to assess if greater registrar input affected discharge rate; an increase in discharge rate was used as a surrogate marker of efficiency.Method:Data was collected prospectively for patients seen in the ENT emergency clinic between 1 August 2009 and 31 July 2011. Time period one included data from patients seen between 1 August 2009 and 31 July 2010, and time period two included data collected between 1 August 2010 and 31 July 2011.Results:The introduction of greater registrar support increased the number of patients that were discharged, and led to a reduction in the number of children requiring the operating theatre.Conclusion:The findings, which were determined using clinic outcomes as markers of the quality of care, highlighted the benefits of increasing senior input within the ENT emergency clinic.

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Emergency medical services evaluations for chest pain during first COVID-19 lockdown in Hollands-Midden, the Netherlands

Netherlands Heart Journal ◽

10.1007/s12471-021-01545-y ◽

2021 ◽

Vol 29 (4) ◽

pp. 224-229 ◽

Cited By ~ 1

Author(s):

E. R. de Koning ◽

M. J. Boogers ◽

J. Bosch ◽

M. de Visser ◽

M. J. Schalij ◽

...

Keyword(s):

Chest Pain ◽

Emergency Medical Services ◽

Medical Services ◽

Cardiac Symptoms ◽

Emergency Medical ◽

Time Period ◽

Number Of Patients ◽

St Elevation ◽

Pain Patients ◽

Hospital Cardiac Arrest

Abstract Objective To assess whether the COVID-19 lockdown in 2020 had negative indirect health effects, as people seem to have been reluctant to seek medical care. Methods All emergency medical services (EMS) transports for chest pain or out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served > 800,000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and during the same time period in 2019. The primary endpoint was the number of evaluated chest pain patients in both cohorts. In addition, the number of EMS evaluations of ST-elevation myocardial infarction (STEMI) and OHCA were assessed. Results During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, age 62 ± 17 years) compared with 1041 patients (51% male, 63 ± 17 years) in the same period in 2019, which corresponded with a significant relative risk (RR) reduction of 0.88 (95% confidence interval (CI) 0.81–0.96). Similarly, there was a significant reduction in the number of STEMI patients (RR 0.52, 95% CI 0.32–0.85), the incidence of OHCA remained unchanged (RR 1.23, 95% CI 0.83–1.83). Conclusion During the first COVID-19 lockdown, there was a significant reduction in the number of patients with chest pain or STEMI evaluated by the EMS, while the incidence of OHCA remained similar. Although the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be paid to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns.

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Is Call Karma Real? Resident After-Hours On-Call Imaging at the University of Saskatchewan: An Assessment of Call Volumes Including Inter-Resident Variability

Canadian Association of Radiologists Journal ◽

10.1177/08465371211026310 ◽

2021 ◽

pp. 084653712110263

Author(s):

James Huynh ◽

David Horne ◽

Rhonda Bryce ◽

David A Leswick

Keyword(s):

Mean Shift ◽

Mean Values ◽

Body Regions ◽

Time Period ◽

Relative Value ◽

Number Of Patients ◽

After Hours ◽

Disproportionate Number ◽

The University ◽

Changes Over Time

Purpose: Quantify resident caseload during call and determine if there are consistent differences in call volumes for individuals or resident subgroups. Methods: Accession codes for after-hours computed tomography (CT) cases dictated by residents between July 1, 2012 and January 9, 2017 were reviewed. Case volumes by patient visits and body regions scanned were determined and categorized according to time period, year, and individual resident. Mean shift Relative Value Units (RVUs) were calculated by year. Descriptive statistics, linear mixed modeling, and linear regression determined mean values, differences between residents, associations between independent variables and outcomes, and changes over time. Consistent differences between residents were assessed as a measure of good or bad luck / karma on call. Results: During this time there were 23,032 patients and 30,766 anatomic regions scanned during 1,652 call shifts among 32 residents. Over the whole period, there were on average 10.6 patients and 14.3 body regions scanned on weekday shifts and 22.3 patients and 29.4 body regions scanned during weekend shifts. Annually, the mean number of patients, body regions, and RVUs scanned per shift increased by an average of 0.2 (1%), 0.4 (2%), and 1.2 (5%) (all p < 0.05) respectively in regression models. There was variability in call experiences, but only 1 resident had a disproportionate number of higher volume calls and fewer lower volume shifts than expected. Conclusions: Annual increases in scan volumes were modest. Although residents’ experiences varied, little of this was attributable to consistent personal differences, including luck or call karma.

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