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Exploring the Adoption of Implantable Brain Stimulation into Standard of Care for Central Nervous System Disorders Proceedings of a Workshop (2024) / Chapter Skim
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4 Patient Selection and Engagement
Pages 31-40

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From page 31...
... • It is vital to educate a patient on what to expect from the DBS surgery and afterward, as this can have a major effect on the patient's satisfaction and behavior. Clear communication between a patient and providers is crucial.
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From page 32...
... You have a long-term relationship with the patient, whatever the outcome." With that background, several workshop participants reviewed the challenges associated with patient selection and engagement to consider the ethics of ensuring access to all patients and demographics; explored the potential opportunities and collaborations needed to develop informed patient selection practices and equitable access to the technology; and reviewed patients' concerns about possible complications of implantable brain stimulation and how best to inform patients about those complications. PATIENT SELECTION IN THE UNITED KINGDOM'S NATIONAL HEALTH SERVICE Joseph Candelario-Mckeown is a nurse practitioner at the National Hospital for Neurology and Neurosurgery in London with more than 17 years of experience using deep brain stimulation to treat Parkinson's disease, among other areas.
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From page 33...
... BARRIERS TO RECEIVING DEEP BRAIN STIMULATION Rachel Davis, an associate professor of psychiatry at the University of Colorado Anschutz School of Medicine, spoke about four main barriers to getting DBS surgery, using OCD as an example. One barrier is limited access to specialized prerequisite treatment.
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From page 34...
... HELPING PATIENTS DECIDE WHETHER TO HAVE DEEP BRAIN STIMULATION SURGERY Doris Wang, an associate professor in the Department of Neurological Surgery at the University of California, San Francisco, is a neurosurgeon who specializes in providing deep brain stimulation for patient with movement disorders. She spoke about helping patients determine whether DBS surgery is right for them and how to optimize surgical outcomes.
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From page 35...
... " By communicating clearly with patients and other members of the team, such problems can be identified and solved, she added. PROGRAMMING DEEP BRAIN STIMULATION IMPLANTS TO IMPROVE OUTCOMES Alik Widge, an associate professor of psychiatry at the University of Minnesota, where he directs the Translational NeuroEngineering Laboratory, spoke about improving DBS outcomes by learning to do a better job of programming the implants.
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From page 36...
... Cognitive control is impaired in a number of disorders, Widge explained, including depression, OCD, and addiction, and it can be measured objectively. What Widge's team discovered is that DBS of the ventral capsule/ ventral striatum improves cognitive control, and the effect is measurable within a few seconds of a change in stimulation (Basu et al., 2023; Widge et al., 2019)
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From page 37...
... This is very different from classic ideas about changing mood or eliminating thoughts, he said, and it will be important to determine how best to talk to patients to explain to them what to expect. DISCUSSION Perides asked if poor patient selection affects outcomes and overall patient engagement and satisfaction.
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From page 38...
... He said that it is important to work harder at educating patients and general practitioners about the procedure in order to increase the number of referrals. Another hurdle in the United Kingdom is that the National Health Service guidance specifies that a group can open a DBS service only if it includes a DBS nurse, neurologist, surgeon, psychiatrist, psychologist, and speech therapist, so only larger groups can perform DBS services.
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From page 39...
... They think if you go through the evaluation and being a candidate, once you turn on the electricity, they sort of expect symptoms to go away." Part of it may be because patients have seen success stories on social media where the device is turned on and the tremor goes away, she said, and doctors themselves may be partly to blame. "When I counsel patients, I show the best case [of]
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From page 40...
... PREPUBLICATION COPY -- Uncorrected Proofs
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Key Terms

  • deep brain
  • patient selection
  • implantable brain
  • dbs surgery
  • patient prefer

  • helping patients
  • cognitive control
  • dbs patients
  • patient expectations
  • approved dbs

  • motor symptoms
  • percent success
  • success rate
  • nurse practitioner
  • poor patient

  • patient responds
  • brain surgery
  • informed patient
  • patient multiple
  • innovative brain

  • understand patient
  • brain function
  • managing patient
  • patient engagement
  • ocd treatment

  • national hospital
  • widge agreed
  • stimulation uptake
  • patients undergoing
  • widge explained


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