Patients' Expectations in Subthalamic Nucleus Deep Brain Stimulation Surgery for Parkinson Disease

• Published in: World neurosurgery Vol. 82; no. 6; pp. 1295 - 1299.e2
• Main Authors: Hasegawa, Harutomo, Samuel, Michael, Douiri, Abdel, Ashkan, Keyoumars
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2014
• Subjects: Aged; Deep brain stimulation; Deep Brain Stimulation - methods; Expectations; Female; Humans; Male; Middle Aged; Neurosurgery; Parkinson disease; Parkinson Disease - physiopathology; Parkinson Disease - psychology; Parkinson Disease - surgery; Patient Satisfaction; Satisfaction; Subthalamic Nucleus; Surveys and Questionnaires; Treatment Outcome; Expectations; Visual analog scale; PDQ-39; DBS; Deep brain stimulation; Satisfaction; Parkinson disease; 39-item Parkinson disease questionnaire; VAS; Subthalamic nucleus; STN
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2014.02.001

Objective Subthalamic nucleus (STN) deep brain stimulation (DBS) is an established treatment for patients with advanced Parkinson disease. However, some patients feel less satisfied with the outcome of surgery. We sought to study the relationship between expectations, satisfaction, and outcome in STN DBS for Parkinson disease. Methods Twenty-two consecutive patients undergoing STN DBS completed a modified 39-item Parkinson disease questionnaire (PDQ-39) preoperatively and 6 months postoperatively. A satisfaction questionnaire accompanied the postoperative questionnaire. Results Patients expected a significant improvement from surgery preoperatively: preoperative score (median PDQ-39 summary score [interquartile range]): 37.0 (9.5), expected postoperative score: 13.0 (8.0), P < 0.001. Patients improved after surgery (preoperative score 39.0 [11.5], postoperative score 25.0 [14.3], P  = 0.003), although there was a substantial disparity between the expected change (24.0 [15.0]) and actual change (14.0 [22.5]), P  = 0.008. However, most patients felt that surgery fulfilled their expectations (mean score on a 0%–100% visual analog scale); (75.3 ± 17.8) and were satisfied (73.3 ± 25.3). Satisfaction correlated with fulfillment of expectations (r = 0.910, P < 0.001) but not with quantitative changes in PDQ-39 scores. Conclusions Addressing patients' expectations both preoperatively and postoperatively may play an important role in patient satisfaction, and therefore overall success, of STN DBS surgery for Parkinson disease.