[HarryO]

Have read that DBS, although available here in the States under certain conditions, generally is available only to later stage PWP, along with other qualifications, but appears to not be available to earlier stage PWP. In Europe, testing on earlier stage PWP has been done and was successful for many in certain areas. Does anyone have feedback on this issue?

[soccertese]

the research seems to indicate that those getting a dbs earlier like it better than taking meds fairly often but regardless, the bigger question is will insurance companies pay for it?

[bigguyclyde]

My understanding is the consensus among neurologists is that if the patient is less than 5 years from initial diagnosis there remains a risk that the patient may actually have an atypical parkinsonism and not PD and therefore the surgery will not be of any benefit to the patient.

Not everyone may agree with this conclusion. But at the present time there are not enough trained neurosurgeons around to perform DBS surgery, so it may be a reasonable way to ration the surgery. Other cut-offs include: age i.e. over 70 years old, co-morbidities, and psychiatric issues. Somehow these factors reduce the candidate pool by 85%. Then only 5% of those qualified will accept the surgery.

Here is how I expressed this concept to someone who was interested in DBS surgery:
"In a way it's a little like being a firefighter. If you took a village of 1000 people, only 150 might be qualified for the job, and of those 150 less than a dozen might decide to fight fires. The rest might decide to say no thanks, I'll try something easier that carries fewer risks."


Clyde

[soccertese]

http://www.jwatch.org/jn201302130000...kinson-disease

i'm sure there is more discussion to be found since i'm sure this was controversial. some researchers also think dbs in younger patients might slow progression. i believe okun is very pro dbs, at least that's the impression i get from his book..

not taking sides, just a messenger.

[dilmar]

Harryo I always thought it was the opposite of what you wrote. I believed DBS was done much earlier in the US than in Europe. This belief was purely on my impressions and wasnt based on facts. Guess there will be comparative stats somewhere.
I do have one aquaintence in the US who had DBS in 2010 just one month after her formal diagnosis.