ANALYSIS OF THE REASONS FOR REFUSAL OF NEUROSURGICAL TREATMENT TO PATIENTS WITH PARKINSON'S DISEASE WHEN REFERRED TO AN EXTRAPYRAMIDAL CENTER

Abstract

The article presents data from a retrospective study analyzing the reasons for refusal of neurosurgical treatment (deep brain stimulation - DBS) in patients with Parkinson's disease referred to an extrapyramidal center and then to a neurosurgical center over a 10-year period. After screening, 78.6% of patients referred as candidates for neurosurgical treatment to an extrapyramidal center were refused DBS, 21.4% of patients were referred to a neurosurgical center, where 12% underwent surgery. The main reasons for refusal when selecting patients for DBS were: "early referral", "inadequate drug therapy", "levodopa-insensitive symptoms", "atypical/secondary parkinsonism", "cognitive reasons", "psychiatric reasons", "comorbidity", "abnormal MRI", "poor response to levodopa drugs" and "abstained from surgery". Also, over 10 years, the number of independent referrals has decreased, more patients have been referred by neurologists, the number of DBS refusals for referring “unsuitable” candidates for surgery has decreased, and the number of “suitable” candidates referred to the extrapyramidal center has increased. In addition, the number of patients referred and operated on at the neurosurgical center has increased, which suggests that physicians are more aware of the selection criteria, and that neurologists at both the primary care and specialized center levels have a higher level of knowledge and experience.