Objective: To identify essential tremor (ET) patients’ attitudes towards deep brain stimulation (DBS) surgery, and how a patient’s level of impairment, assessment of risk, and relationship with their neurologist might impact those attitudes.

Background: Despite its proven efficacy in the management of ET, DBS may be under-utilized by patients who would otherwise benefit from therapy. However, the reasons for this under-utilization have not been explored in detail.

Methods: Patients evaluated at the Yale Movement Disorders Center for a diagnosis of ET between June 2014 and June 2016 were identified by chart review. They were contacted consecutively to participate in a semi-structured interview regarding their level of impairment, surgical receptivity (based on the self-reported likelihood of undergoing DBS on a scale of 0-100), and whether they felt they were adequately informed as to their diagnosis and available treatment options. Interviews were reviewed to identify common themes regarding their perception of DBS.

Results: Thirty-seven ET patients without DBS, and six patients with DBS, elected to participate in interviews. All patients had tried 1 or more medications to treat tremor. Of those patients without DBS, 20/37 (54%) described themselves as “not open to surgery” (receptivity score 0-49). 17/37 (46%) described themselves as “open to surgery” (receptivity score 50-100). The proportion of patients who described themselves as “impaired by tremor” in these two groups were 60% (12/20) and 88% (15/17), respectively. The most commonly cited reason for not being “open to surgery” was fear of surgery. Those who were impaired by tremor and “open to surgery” cited a recommendation from their neurologist as the single most important factor in making a hypothetical decision to pursue DBS surgery. Patients “open to surgery” and “not open to surgery” had similar estimates of the risk of adverse events (5-10%) and benefit in tremor (75-100%) from DBS.

Conclusions: Fear of surgery is the greatest factor limiting ET patients’ receptivity to DBS. This appears independent of their perceived risk of surgery or the benefits of DBS for tremor. For those patients “open to surgery,” their neurologist’s recommendation may have a significant impact on the decision to pursue DBS. Earlier discussions of the range of treatment options available for ET may expand DBS utilization to patients who report tremor as impairing their daily activities.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/receptivity-to-deep-brain-stimulation-surgery-among-patients-with-essential-tremor/