Patient Expectations May Be Potent Factor in DBS for Parkinson’s Disease
Pedunculopontine nucleus (PPN) stimulation is a newer technique under investigation that may allow for additional leads to be placed in a patient’s brain. Leads can be implanted on one or both sides of the brain and can be used with GPI or STN leads.
Future DBS devices may enable the remote adjustment of stimulation settings. Nurses and patients also may be able to adjust the devices. DBS increasingly will be tailored to individuals’ symptoms and profiles, and devices may deliver scheduled, responsive, and smart stimulation, Dr. Okun said.
When any new device is introduced to the market, there is “a peak of inflated expectation” about the technology, Dr. Okun said. Then, expectations drop as people discover the device’s limitations. Finally, expectations increase and level as people come to better understand and use the technology. In Parkinson’s disease, neurologists and neurosurgeons are beginning to reach a “plateau of productivity where thousands of people can be helped” by current DBS therapies, he said.
—Jake Remaly
Suggested Reading
Hariz GM, Limousin P, Tisch S, et al. Patients’ perceptions of life shift after deep brain stimulation for primary dystonia--a qualitative study. Mov Disord. 2011;26(11):2101-2106.
Higuchi MA, Martinez-Ramirez D, Morita H, et al. Interdisciplinary Parkinson’s disease deep brain stimulation screening and the relationship to unintended hospitalizations and quality of life. PLoS One. 2016;11(5):e0153785.
Keitel A, Ferrea S, Südmeyer M, et al. Expectation modulates the effect of deep brain stimulation on motor and cognitive function in tremor-dominant Parkinson’s disease. PLoS One. 2013;8(12):e81878.
Maier F, Lewis CJ, Horstkoetter N, et al. Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson’s disease: a mixed-method approach. J Neurol Neurosurg Psychiatry. 2013;84(11):1273-1281.
Nisenzon AN, Robinson ME, Bowers D, et al. Measurement of patient-centered outcomes in Parkinson’s disease: what do patients really want from their treatment? Parkinsonism Relat Disord. 2011;17(2):89-94.
