Patient selected goals and satisfaction after bilateral subthalamic nucleus deep brain stimulation in Parkinson's disease. (June 2020)

• Record Type: Journal Article
• Authors: Nam, Seon Kyung; Yoo, Dallah; Lee, Woong-Woo; Jang, Mihee; Kim, Hee Jin; Kim, Young Eun; Park, Hye Ran; Ehm, Gwanhee; Yang, Hui-Jun; Yun, Ji Young; Shin, Chaewon; Kim, Han-Joon; Jeon, Beomseok
• Is Part Of: Journal of clinical neuroscience. Volume 76(2020)
• Page Start: 148
• Page End: 153
• Publication Date: 2020-06
• Subjects: Deep brain stimulation -- Movement disorders -- Neurosurgery -- Parkinson's disease -- Patient satisfaction; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.04.005
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Top three pre-DBS goals were dyskinesia, gait, and medication off duration. 80.0% of patients did not recall the same goals or changed goals after six months. Post-DBS goal achievement score significantly correlated with patient satisfaction. Motor outcomes after STN-DBS did not correlate with patient satisfaction. Abstract: Assessing patient goals is crucial in understanding patient centered outcomes and satisfaction. However, patient goals may change throughout treatment. Our objective is to identify the changes in patient-selected goals of Parkinson's disease (PD) patients undergoing bilateral subthalamic nucleus deep brain stimulation (STN-DBS) and examine the relationship among patient-selected goal achievement, standard DBS outcome measures, and overall patient satisfaction. Seventy-five patients undergoing bilateral STN-DBS listed three patient-selected goals before surgery. After six months, patients were asked to restate the three goals and to rate the degree of goal achievement and the overall satisfaction of surgery. The three most frequently selected goals were "dyskinesia", "gait disorder", and "medication off duration". After six months, 80.0% of patients could not accurately recall their pre-DBS goals. "Dyskinesia" was the most consistently selected goal, more patients selected "tremor" and "less medication" at post-DBS compared to pre-DBS, and less patients selected "gait disorder" at post-DBS compared to pre-DBS. 74.7% of patients reported overall satisfaction by stating they were "very much" or "much better after surgery". Patient satisfaction significantly correlated with goal achievement (r = 0.640; p < 0.001). Interestingly, change in UPDRS motor scores did not correlate with patient satisfaction (r = 0.100; p = 0.395). Although recalled goals do not accurately represent the pre-surgical goals, the achievement score for recalled goals significantly correlated with patient satisfaction. Patient goals change due to many reasons. Therefore, follow-up patient counseling to discuss goals and outcomes is important in improving patient satisfaction after STN-DBS.