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Selection of Deep Brain Stimulation Candidates in Private Neurology Practices: Referral May Be Simpler than a Computerized Triage System

Authors

  • Genko Oyama MD, PhD,

    1. Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA;
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  • Ramon L. Rodriguez MD,

    1. Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA;
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  • Jacob D. Jones BA,

    1. Department of Clinical & Health Psychology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA;
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  • Camille Swartz BS,

    1. Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA;
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  • Stacy Merritt MA,

    1. Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA;
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  • Richard Unger MD,

    1. Neurology Institute of Melbourne, P.A., Melbourne, FL, USA;
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  • Monica Hubmann ARNP,

    1. Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA;
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  • Alain Delgado MD,

    1. Neurology and Neurosurgery Associates, P.A., Winter Haven, FL, USA;
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  • Ely Simon MD,

    1. NeuroTrax Corporation, Bellaire, TX, USA; and
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  • Glen M. Doniger PhD,

    1. NeuroTrax Corporation, Bellaire, TX, USA; and
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  • Dawn Bowers PhD,

    1. Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA;
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  • Kelly D. Foote MD,

    1. Department of Neurosurgery, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA;
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  • Hubert H. Fernandez MD,

    1. Department of Neurology, Cleveland Clinic, Center for Neurological Resotration, Cleveland, OH, USA
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  • Michael S. Okun MD

    Corresponding author
    1. Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA;
    2. Department of Neurosurgery, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA;
      Michael S. Okun, MD, 100 S Newell Dr, Room L3-101, Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL 32610, USA. Email: okun@neurology.ufl.edu
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  • Conflict of Interest: None.

  • Financial support: Drs. Okun, Foote, and Fernandez, and Dr. Simon of the NeuroTrax Corporation, participated in the construction of the FLASQ-PD and COMPRESS software for DBS screening. Drs. Simon and Doniger are employees of NeuroTrax. Drs. Okun, Foote, and Fernandez currently have no royalty interest. <Correction added after online publication 29 February 2012: The original version of this article contained an error in Dr. Hubert H. Fernandez's name. It has been corrected in this version.>

Michael S. Okun, MD, 100 S Newell Dr, Room L3-101, Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL 32610, USA. Email: okun@neurology.ufl.edu

Abstract

Objective:  The objective of this study is to compare a computerized deep brain stimulation (DBS) screening module (Comparing Private Practice vs. Academic Centers in Selection of DBS Candidates [COMPRESS], NeuroTrax Corp., Bellaire, TX, USA) with traditional triage by a movement disorders specialized neurologist as the gold standard.

Methods:  The COMPRESS consists of a combination of the Florida Surgical Questionnaire for Parkinson disease (FLASQ-PD), a cognitive assessment battery provided by MindStreams® (NeuroTrax Corp.), and the Geriatric Depression Scale and the Zung Anxiety Self-Assessment Scale. COMPRESS resulted in the classification of patients into three categories: “optimal candidate,”“probable candidate,” and “not a good candidate.” Similar categorical ratings made by a referring private practice neurologist and by a trained movement disorders specialist were compared with the ratings generated by COMPRESS.

Results:  A total of 19 subjects with Parkinson's disease were enrolled from five private neurological practices. The clinical impressions of the private practice neurologist vs. those of the movement disorders specialist were in agreement approximately half the time (10/19 cases). The movement disorders specialist and COMPRESS agreed on 15/19 cases. A further comparison between outcomes from the entire COMPRESS module and the FLASQ-PD questionnaire by itself resulted in high agreement (18/19 cases in agreement).

Conclusions:  The COMPRESS agreed with an in-person evaluation by a movement disorders neurologist approximately 80% of the time. The computerized COMPRESS did not provide any screening advantage over the short FLASQ-PD paper questionnaire. Larger studies will be needed to assess the utility and cost effectiveness of this computerized triage method for DBS.

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