TY - JOUR
T1 - Factors associated with receptivity to deep brain stimulation surgery among essential tremor cases
AU - Louis, Elan D.
AU - Gillman, Arthur
N1 - Funding Information:
R01 NS42859 from the National Institutes of Health (Bethesda, MD) and the Parkinson’s Disease Foundation .
PY - 2011/7
Y1 - 2011/7
N2 - Background: A sizable proportion of essential tremor (ET) patients suffer from medically-refractory ET. Although deep brain stimulation (DBS) surgery is a safe and highly effective treatment, it may be under-utilized. We are unaware of studies that assess ET patients' attitudes toward DBS surgery and the factors that motivate them toward or away from such surgery. Methods: ET cases, enrolled in an ongoing clinical-pathological study, underwent an in-person evaluation. They were asked "What is the likelihood that you would allow yourself to have DBS surgery?", thus rating their 'surgical receptivity' from 0 to 100. Results: One-third (47/146, 32.2%) of ET cases reported that they would consider DBS surgery. In univariate analyses, younger age (p = 0.017), self-reported embarrassment (p = 0.001), more depressive symptoms (p = 0.008), more dysthymia (p = 0.029), higher total tremor score (marginal p = 0.13) and lower burden of medical comorbidity (marginal p = 0.16) were associated with greater surgical receptivity. In multivariate logistic regression models, only self-reported embarrassment (p = 0.006) and, marginally, younger age (p = 0.059) were independently associated with surgical receptivity. Conclusions: We identified a number of factors that were associated with increased receptivity to DBS surgery. Interestingly, psychosocial variables (dysthymia, depressive symptoms, self-reported embarrassment) featured prominently among these factors; indeed, self-reported embarrassment was the most robust factor. Tremor severity, though associated in univariate analyses with increased surgical receptivity, was not as robust of a predictor as was self-reported embarrassment. Future studies, which are community-based as well as those which also assess the patient's level of understanding about DBS will further add to the literature on this topic.
AB - Background: A sizable proportion of essential tremor (ET) patients suffer from medically-refractory ET. Although deep brain stimulation (DBS) surgery is a safe and highly effective treatment, it may be under-utilized. We are unaware of studies that assess ET patients' attitudes toward DBS surgery and the factors that motivate them toward or away from such surgery. Methods: ET cases, enrolled in an ongoing clinical-pathological study, underwent an in-person evaluation. They were asked "What is the likelihood that you would allow yourself to have DBS surgery?", thus rating their 'surgical receptivity' from 0 to 100. Results: One-third (47/146, 32.2%) of ET cases reported that they would consider DBS surgery. In univariate analyses, younger age (p = 0.017), self-reported embarrassment (p = 0.001), more depressive symptoms (p = 0.008), more dysthymia (p = 0.029), higher total tremor score (marginal p = 0.13) and lower burden of medical comorbidity (marginal p = 0.16) were associated with greater surgical receptivity. In multivariate logistic regression models, only self-reported embarrassment (p = 0.006) and, marginally, younger age (p = 0.059) were independently associated with surgical receptivity. Conclusions: We identified a number of factors that were associated with increased receptivity to DBS surgery. Interestingly, psychosocial variables (dysthymia, depressive symptoms, self-reported embarrassment) featured prominently among these factors; indeed, self-reported embarrassment was the most robust factor. Tremor severity, though associated in univariate analyses with increased surgical receptivity, was not as robust of a predictor as was self-reported embarrassment. Future studies, which are community-based as well as those which also assess the patient's level of understanding about DBS will further add to the literature on this topic.
KW - Clinical
KW - Deep brain stimulation surgery
KW - Embarrassment
KW - Essential tremor
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U2 - 10.1016/j.parkreldis.2011.04.010
DO - 10.1016/j.parkreldis.2011.04.010
M3 - Article
C2 - 21561796
AN - SCOPUS:79959370860
SN - 1353-8020
VL - 17
SP - 482
EP - 485
JO - Parkinsonism and Related Disorders
JF - Parkinsonism and Related Disorders
IS - 6
ER -