Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-06-10T15:50:44.370Z Has data issue: false hasContentIssue false
  • English
  • Français

Referrals for Movement Disorder Surgery: Under-Representation of Females and Reasons for Refusal

Published online by Cambridge University Press:  02 December 2014

M. Setiawan ,
S. Kraft ,
K. Doig ,
K. Hunka ,
A. Haffenden ,
M. Trew ,
S. Longman ,
R. Ranawaya ,
S. Furtado  and
R.G. Lee
...Show all authors
M. Setiawan
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
S. Kraft
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
K. Doig
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
K. Hunka
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
A. Haffenden
Affiliation:
Department of Psychology, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
M. Trew
Affiliation:
Department of Psychiatry, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
S. Longman
Affiliation:
Department of Psychology, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
R. Ranawaya
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
S. Furtado
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
R.G. Lee
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
O. Suchowersky
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
Z.H.T. Kiss*
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital - Calgary Health Region, Calgary, AB, Canada
*
Rm 182A, Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

Referral of movement disorder patients for deep brain stimulation surgery was examined to determine whether referred patients were representative of gender proportions in our population, and reasons why patients do not proceed to surgery.

Methods:

Demographic information on referrals to the surgical program was retrospectively reviewed from our database and from a detailed chart review.

Results:

Although almost equal numbers of movement disorder patients are male and female, of the 91 patients referred for surgery, only 31% were female. Sixty-one percent of referred patients did not undergo surgery. Of these, the majority were denied for medical reasons, including cognitive decline (21%), psychiatric concerns (5%) and neurological reasons (42%).

Conclusions:

Almost one-third of patients referred for movement disorder surgery were denied for medical reasons. This underscores the importance of evaluation of all potential patients by a multidisiplinary team to fully assess suitablity for stereotactic surgery. Interestingly, women were under-represented in those referred. In order that all appropriate patients have the opportunity to consider surgery, education of both physicians and patients, and different strategies to approach females regarding surgery may allow more patients to benefit from this treatment.

Résumé

RÉSUMÉObjectif:

L'orientation des patients atteints de troubles du mouvement vers la neurochirurgie pour stimulation cérébrale profonde a été examinée afin de déterminer si la proportion de ces patients par sexe était représentative de cette proportion dans notre population et pourquoi un certain nombre de ces patients ne subissent pas l'intervention.

Méthodes:

Il s'agit d'une analyse rétrospective de l'information démographique sur les patients orientés en chirurgie contenue dans notre base de données et obtenue également d'une revue détaillée de dossiers.

Résultats:

Bien qu'un nombre presque égal d'hommes et de femmes soient atteints de troubles du mouvement, seulement 31% des 91 patients orientés en chirurgie étaient des femmes. La chirurgie n'a pas été effectuée chez soixante et un pour cent d'entre eux, la plupart du temps pour des raisons médicales, soit un déclin cognitif chez 21%, des problèmes de nature psychiatrique chez 5% et de nature neurologique chez 42%.

Conclusions:

Un peu moins du tiers des patients orientés vers la chirurgie pour un trouble du mouvement n'ont pas subi cette chirurgie pour des raisons médicales. Cette constatation souligne l'importance d'une évaluation globale par une équipe multidisciplinaire de tous les patients candidats à la chirurgie stéréotaxique. Il est intéressant de noter que les femmes étaient sous-représentées parmi les patients orientés vers la chirurgie. Pour que tous les patients éligibles aient la possibilité d'y avoir accès, l'éducation des médecins et des patients et des stratégies différentes pour rejoindre les femmes pourraient permettre à un plus grand nombre de patients d'en bénéficier.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 33 , Issue 1 , February 2006 , pp. 53 - 57
Copyright
Copyright © The Canadian Journal of Neurological 2006

References

1. Krack, PP, Batir, A, Van Blercom, N, Chabardes, S, Fraix, V, Ardouin, C, et al. Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med. 2003; 349[20]: 1925–34.Google Scholar
2. Schuurman, PR, Bosch, DA, Bossuyt, PMM, Bonsel, GJ, Van Someren, EJW, de Bie, RM, et al. A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med. 2000; 342[7]: 461–8.Google Scholar
3. Hariz, G, Hariz, MI. Gender distribution in surgery for Parkinson’s disease. Parkinsonism Relat Disord. 2000; 6[3], 155–7.CrossRefGoogle Scholar
4. Hariz, GM, Lindberg, M, Hariz, MI, Bergenheim, AT. Genderdifferences in disability and health-related quality of life in patients with Parkinson–s disease treated with stereotactic surgery. Acta Neurol Scand. 2003; 108[1]: 28–37.CrossRefGoogle Scholar
5. Vercueil, L, Krack, PP, Pollak, P. Results of deep brain stimulation fordystonia: A critical reappraisal. Mov Disord. 2002; 17[Suppl 3]:S89–S93.Google Scholar
6. Russmann, H, Ghika, J, Villemure, JG, Robert, B, Bogousslavsky, J, Burkhard, PR, et al. Subthalamic nucleus deep brain stimulation in Parkinson disease patients over age 70 years. Neurology. 2004; 63[10]: 1952–4.Google Scholar
7. Welter, ML, Houeto, JL, Tezenas du Montcet, S, Mesnage, V, Bonnet, AM, Pillon, B, et al. Clinical predictive factors of subthalamic stimulation in Parkinson’s disease. Brain. 2002; 125[Pt 3]:575–83.Google Scholar
8. Tröster, AI, Fields, JA, Pahwa, R, Wilkinson, SB, Straits-Tröster, KA, Lyons, K, et al. Neuropsychological and quality of life outcome after thalamic stimulation for essential tremor. Neurology. 1999; 53: 1774–80.Google Scholar
9. Herrera, EJ, Viano, JC, Caceres, M, Costello, G, Suarez, M, Suarez, JC. Posteroventral pallidotomy in Parkinson’s disease. Acta Neurochir. (Wien.) 2000; 142[2]: 169–175.CrossRefGoogle ScholarPubMed
10. Uitti, RJ, Wharen, RE Jr., Turk, MF, Lucas, JA, Finton, MJ, Graff-Radford, NR, et al. Unilateral pallidotomy for Parkinson’s disease: comparison of outcome in younger versus elderly patients. Neurology. 1997; 49[4]: 1072–7.Google Scholar
11. Liu, X, Aziz, TZ, Miall, RC, Rowe, J, Alusi, SH, Bain, PG, et al. Frequency analysis of involuntary movements during wrist tracking: a way to identify MS patients with tremor who benefit from thalamotomy. Stereotact Funct Neurosurg. 2000; 74[2]: 53–62.CrossRefGoogle ScholarPubMed
12. Berk, C, Carr, J, Sinden, M, Martzke, J, Honey, CR. Thalamic deepbrain stimulation for the treatment of tremor due to multiple sclerosis: a prospective study of tremor and quality of life. J Neurosurg. 2002; 97[4]: 815–20.CrossRefGoogle Scholar
13. Svenson, LW, Platt, GH, Woodhead, SE. Geographic variations in theprevalence rates of Parkinson’s disease in Alberta. Can.J Neurol Sci. 1993; 20[4]: 307–11.Google Scholar
14. Jankovic, J, Kapadia, AS. Functional decline in Parkinson disease. Arch. Neurol. 2001; 58[10]: 1611–5.Google Scholar
15. Council on Ethical and Judicial Affairs AMA. Gender disparities inclinical decision making. JAMA. 2004; 266[4]: 559–62.Google Scholar
16. Schulman, KA, Berlin, JA, Harless, W, Kerner, JF, Sistrunk, S, Gersh, BJ, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999; 340[8]: 618–26. Google Scholar
17. Herold, AH, Riker, AI, Warner, EA, Woodard, LJ, Brownlee, HJ Jr., Pencev, D, et al. Evidence of gender bias in patients undergoing flexible sigmoidoscopy. Cancer Detect.Prev. 1997; 21[2]: 141–7.Google Scholar
18. Wanzel, KR, Brown, MH, Anastakis, DJ, Regehr, G. Reconstructivebreast surgery: referring physician knowledge and learning needs. Plast Reconstr Surg. 2002; 110[6]: 1441–50.Google Scholar
19. Burkhard, PR, Vingerhoets, FJ, Berney, A, Bogousslavsky, J, Villemure, JG, Ghika, J. Suicide after successful deep brain stimulation for movement disorders. Neurology. 2004; 63[11]: 2170–2.Google Scholar
20. Houeto, JL, Mesnage, V, Mallet, L, Pillon, B, Gargiulo, M, du Moncel, ST, et al. Behavioural disorders, Parkinson’s disease and subthalamic stimulation. J Neurol Neurosurg Psychiatry. 2002; 72[6]: 701–7.Google Scholar
21. Eisler, T, Svensson, O, Tengstrom, A, Elmstedt, E. Patient expectationand satisfaction in revision total hip arthroplasty. J Arthroplasty. 2002; 17[4]: 457–62.Google Scholar
22. McGregor, AH, Hughes, SP. The evaluation of the surgicalmanagement of nerve root compression in patients with low back pain: Part 2: patient expectations and satisfaction. Spine. 2002; 27[13]: 1471–6.Google Scholar