Objective: To examine effect of preoperative expectations on postoperative satisfaction in individuals with PD treated with DBS

Background: While clinical trials of DBS in PD have demonstrated a clear benefit on motor function in appropriately selected patients, improvement in motor function does not necessarily translate to perceived benefit by the patient or improved quality of life (1). Expectations of DBS outcome are among the most important factors that contribute to self-reported patient satisfaction with DBS (2).

Methods: Data was abstracted from the Penn Parkinson’s Center Specialty Assessment and Evaluation for DBS (SAFE-DBS) clinic database. At the University of Pennsylvania Parkinson’s Disease and Movement Disorders Center, DBS candidates are seen in a multidisciplinary clinic preoperatively. They complete a questionnaire about expectations prior to evaluation, which is subsequently reviewed with them in detail. In cases of unrealistic expectations, extensive counseling is provided to educate the patient. For patients enrolled in the database, follow up questionnaires, including the PDQ-8, are administered post-operatively at 1 year to assess satisfaction with multiple symptoms and overall quality of life. Improved cognition, balance, and speech were considered unrealistic expectations whereas improvements in tremor, gait, dyskinesias, quality of life, and medication reduction were considered realistic expectations. 

Results: 9 patients (mean age 59.3 y; range 50.29-72.07; 2 female, 8 with bilateral STN implants and 1 bilateral GPi implants, median disease duration 8 y) completed baseline and 1 year postoperative assessment and were included.  3 patients had at least one unrealistic expectation at baseline but of these patients, PDQ-8 improved in 2/3 (66%). Of items assessed pre and post-operatively, 14/18 (78%) realistic expectations were met at the 1y followup and 2/2 unrealistic expectations were unmet.  Two patients had realistic expectations that were unmet, one of which had a reduction in PDQ-8 at 1 year. Overall 6/9 (66%) had stable or improved PDQ-8 scores 1 year postoperatively [table 1].

Conclusions: In PD patients undergoing DBS, unrealistic baseline expectations do not necessarily translate to negative perceived outcome. The role of preoperative counseling/education in mitigating negative impact of unrealistic preoperative expectations may be helpful and deserves further study.

References: 1.Diamond, Adele, and Joseph Jankovic. “The effect of deep brain stimulation on quality of life in movement disorders.” Journal of Neurology, Neurosurgery & Psychiatry 76.9 (2005): 1188-1193.

2. Maier, Franziska, et al. “Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson’s disease: a mixed-method approach.” Journal of Neurology, Neurosurgery & Psychiatry 84.11 (2013): 1273-1281.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/expectations-and-perceived-outcomes-following-dbs-for-pd-a-case-series/