Objective: To study the time to deep brain surgery (DBS) for movement disorders and breaking down the time to each step in the DBS process, i.e. consultations with various services and investigations.

Background: Canada has a publicly funded healthcare system, grounded in equity and universality. Canada Health Act emphasizes “reasonable access to medically necessary hospital and physician services”. DBS is an important treatment for Parkinson’s disease, tremor, and dystonia in appropriately selected patients. Timely access to DBS is crucial as disease progression and aging can result in patients missing the therapeutic window. Breaking down the timing of steps from referral to surgery can identify barriers to access and inform strategies to reduce delays in surgical treatment.

Method: A total of 44 DBS patients from January 2015 to February 2020 at the University of Alberta were included. The date of DBS neurologist’s referral to the interdisciplinary DBS team marked the start of the workup (day 0). Time to additional consults and to surgery were analyzed.

Results: Time from initial referral to the DBS neurologist and decision to move forward with formal DBS workup was 205.7+/-156.4 (22-525) days. Reasons for the wide range were multiple, encompassing factors such as patient availability, reluctance to undergo neurosurgery, and the need for an additional visit for levodopa challenge. Time to neurosurgical consult was 79.7+/-81.2 days. Time to neuropsychology and psychiatry consult was 149.5+/-95.5 and 146.3+/-100.3 days respectively. Time to physical/occupational therapy functional assessment was 141.7+113.3 days. Screening MRI completion took 102.7+/-100.2 days. Average time to consent for surgery from initial referral was 242.1+/-94.9 days. Total time from initial decision for DBS workup to surgery was 381.6+/-119.9 days.

Conclusion: This single center study analyzed the time breakdown required for each step of the process, from referral to the DBS neurologist to surgery. Utilization of DBS in Canada is low (10 cases/1,000,000/year) which has limited large-scale studies, including analyzing the process and time to surgery. Time of more than one year from initiation of the process to surgery is not optimal in a publicly funded system for these progressive/degenerative diseases. Future studies are needed to evaluate the barriers to receiving DBS to optimize patient care.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/time-from-referral-to-dbs-a-single-centre-canadian-study/