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

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 ST...

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Bibliographic Details
Published in:	World neurosurgery 2014-12, Vol.82 (6), p.1295-1299.e2
Main Authors:	Hasegawa, Harutomo, Samuel, Michael, Douiri, Abdel, Ashkan, Keyoumars
Format:	Article
Language:	eng
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
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Summary:	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.
ISSN:	1878-8750 1878-8769