Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI, USA.
Department of Neurology, Michigan State University, East Lansing, MI, USA.
Clin Neurol Neurosurg. 2021 Apr;203:106553. doi: 10.1016/j.clineuro.2021.106553. Epub 2021 Feb 10.
To guide responsive policy and better understand factors that might shape patients' decisions to have DBS earlier, we explore perspectives and attitudes toward earlier deep brain stimulation (DBS) of Parkinson disease (PD) patients with DBS.
Before the US Food and Drug Administration released its change of indication for the use of DBS for PD, several groups had performed DBS earlier in disease course.
We designed an online survey comprising Likert-type, multiple choice, and rank-order questions and distributed it to PD patients. We analyzed patient considerations for having chosen DBS and for choosing or rejecting to have DBS earlier, as well as factors potentially shaping perspectives around DBS and its timing. Data was analyzed using descriptive and inferential statistics.
Among the 160 participants in the sample, the most important consideration for choosing DBS was the possibility of better symptomatic control compared to medication alone. The most important consideration for delaying DBS was possible ineffectiveness. 41.3 % (n = 66) of respondents supported earlier DBS use, 38.8 % (n = 62) did not, and the remainder (n = 30) were uncertain. Patients who supported earlier DBS use cited the possibility of better symptomatic control than with medication alone, while those who did not support earlier use felt that medication options should be exhausted first.
Our results suggest that there are multiple factors shaping patient perceptions around earlier DBS implantation. Future work should compare perceptions before and after DBS implantation, as well as pair perceptions with clinical outcomes.
为了指导有针对性的政策制定，并更好地了解可能影响患者更早接受脑深部电刺激（DBS）治疗决策的因素，我们探讨了对帕金森病（PD）患者更早接受 DBS 治疗的看法和态度。
在美国食品和药物管理局（FDA）发布改变 DBS 治疗 PD 的适应证之前，已有几个研究小组在疾病早期就开展了 DBS 治疗。
我们设计了一个在线调查，包含李克特量表、多项选择题和排序题，并将其分发给 PD 患者。我们分析了患者选择 DBS 的考虑因素，以及选择或拒绝更早接受 DBS 的原因，以及可能影响 DBS 及其时机的看法的因素。使用描述性和推断性统计方法对数据进行分析。
在 160 名样本参与者中，选择 DBS 的最重要考虑因素是与单独药物治疗相比，DBS 治疗更有可能改善症状控制。延迟 DBS 的最重要考虑因素是可能无效。41.3%（n=66）的受访者支持更早使用 DBS，38.8%（n=62）不支持，其余 30%（n=30）不确定。支持更早 DBS 治疗的患者认为 DBS 治疗可能比单独药物治疗有更好的症状控制效果，而不支持更早使用 DBS 治疗的患者则认为应首先用尽药物治疗选择。
我们的结果表明，有多种因素影响患者对更早接受 DBS 植入的看法。未来的研究应该比较 DBS 植入前后的看法，以及将看法与临床结果进行配对。
