Objective: To assess barriers to accessing Deep Brain Stimulation (DBS), as a function of the time required for each step of the workup and how the COVID-19 pandemic affected the timelines for access.

Background: DBS is an effective and life-changing treatment for people with Parkinson’s disease (PD), tremor, and dystonia in carefully selected patients. Despite being covered under universal healthcare in Canada, DBS is underutilized, and various barriers exist in access to DBS. One of the major barriers in a publicly funded system is the wait time associated with a workup process by an interdisciplinary team. An extended wait time could contribute to precipitated functional decline leading to loss of eligibility for DBS. The Canada Health Act emphasizes equity and “reasonable access to medically necessary hospital and physician services”. What constitutes reasonable access unfettered by barriers and whether this standard is routinely met has not been well studied. We aim to assess access to DBS particularly related to the workup timeline and whether there are specific barriers to DBS. The second focus is to analyze the impact of COVID-19 pandemic on the DBS evaluation process and patients’ potential functional decline.

Method: We set the decision to proceed with DBS as marking the start of the work-up and analyzed the access to care timelines for implants from 2015 to 2022 at the University of Alberta. Specifically, we analyzed the time required to see other specialists and healthcare allies on the team and the impact COVID-19 had on those access to care timelines.

Results: The total time from starting the work-up to DBS surgery was 387.76 ± 125.19 days prior to COVID-19, and marked delay occurred during and post-COVID-19 (839.78 ±  240.47 days). Most workups were done within 6 months, although a big range existed due to variable factors. The major delay to surgery was from consent to DBS. Pre-pandemic, no patients lost their candidacy status due to functional/cognitive decline during the work-up process. Further, the system has experienced difficulties in recovery even post-pandemic.

Conclusion: Access to DBS should be readily available and in a timely manner for those who fit the stringent criteria. The wait time for DBS, and the consequences related to such have not been well studied in Canada. This study provided a first-hand account and encouraged further study and consideration to optimize access to DBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/time-to-access-deep-brain-stimulation-surgery-for-movement-disorders-a-canadian-single-center-study/