Key Take-Aways:
• Lead placement accuracy now within 1 millimeter, reducing risk of revision surgery and improving outcomes
• Asleep DBS, remote programming, and longer lasting batteries make DBS more convenient and tolerable for patients with movement disorders

 

An estimated 50% of patients with essential tremor are eligible for DBS but have not been referred for evaluation. And fewer than 10% of patients with Parkinson’s undergo DBS, despite overwhelming evidence of its many benefits. Delayed use of DBS has severe consequences on quality of life, ability to continue working, and likelihood of remaining socially engaged.

Patients with essential tremor, Parkinson’s and dystonia are hesitant to undergo DBS due to:

• Lack of awareness about DBS
• Outdated misconceptions about DBS
• Lack of access to DBS and particularly regular follow-up care
• Fears of poor outcomes or surgical risk

Primary care providers and treating neurologists can help overcome these fears by providing updated information about the latest advancements:

• Improved Accuracy: David VanSickle, MD, PhD, FAANS, and Abjiheet Gummadavelli, MD, with Neurosurgery One, are the first in the country to use NaviNetics Reusable Stereotactic System, outside of Mayo Clinic where it was developed. The headframe improves DBS lead placement accuracy to within 1 millimeter or less. Greater accuracy of lead placement means reduced risk of revision surgery and improved outcomes. Denver DBS Center’s rate of revision prior to using NaviNetics was 1%, compared to 15% nationally. Performing DBS with the patient asleep, now performed for the majority of cases, also increases lead placement accuracy.
• Lower Surgical Risks: DBS procedural advancements (including asleep DBS), improved imaging modalities and better stereotactic navigation have decreased surgical time and infection rates along with the rate of revision surgery. Patient conferences to provide comprehensive case evaluation by a team of neurologists, neuropsychologists and neurosurgeons also are greatly improving safety and outcomes.
• Long-Lasting Batteries: Smaller batteries that hold charges longer — some as long as one month — are providing patients with increased freedom, allowing them to travel and to enjoy other activities without the need for frequent recharging.
• Remote programming: Patients no longer need to travel to get their DBS system programmed. Through telehealth video, a neurologist can program the device as patients remain in their home. All programming including the initial monthly programming for the first 6 months and then routine programming every 3-4 months can be done through this service.

Patient Referral Criteria

Recognizing the immense benefit and low risk of DBS, the FDA has significantly lowered the patient threshold for surgical referral. The criteria for surgical referral are the following:

Patients with Parkinson’s Disease:

• Symptoms ≥4 years
• Responsive to levodopa therapy but with motor fluctuations

Patients with Essential Tremor:

• Symptoms impacting quality of life or ADL
• Medication not providing adequate symptom control

DBS Benefits

Nearly 1 million American adults live with Parkinson’s disease. As Parkinson’s progresses, medications may become less effective. First approved by the FDA for Parkinson’s disease in 2002, DBS has been shown to:

• Improved quality of life and motor function in Parkinson’s disease with early motor complications, providing the evidence for the FDA to approve use as soon as 4 years after symptom onset
• Improves motor function and reduces severity of dyskinesia
• Results last more than 10 years
• Reduces medication use
• Improves quality of life
• Extends life

Essential tremor is among the most common movement disorders in the world, affecting nearly 10 million Americans — a number that is rapidly increasing with our aging society. While ET does not have direct profound physical impact, it is a devastating condition nonetheless. ET negatively impacts a patient’s ability to function independently and has negative psychosocial effects, including social fear and embarrassment that can lead to isolation and diminished mental, emotional and physical health.

Approximately 50% of people with ET can be effectively treated with medications, with beta-blockers and primidone being the most commonly prescribed medications. Yet, it is estimated that only about 3% of patients get DBS.  For drug-resistant patients, surgery should be considered with DBS being the optimal procedure.

• DBS provides adequate tremor control in 90% of ET patients, with low morbidity and mortality.
• Approved since 1997 to treat essential tremor, DBS is effective in suppressing ET for ≥6 years after implantation.

To make a patient referral, please use our online HIPAA-compliant referral form or call 720-638-7500.

 

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