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Abstract Details

Multidisciplinary and Telemedicine Pre-operative Evaluations for Deep Brain Stimulation Candidates
Movement Disorders
P1 - Poster Session 1 (8:00 AM-9:00 AM)
3-004

Before 2019, pre-operative DBS evaluation at our center involved neurological, neuropsychological, and neurosurgical assessment. In late 2019, an expanded multidisciplinary evaluation (MDE; including psychiatry and psychology) and a systematically documented consensus meeting (CM) was phased in to assess DBS candidacy. The COVID-19 pandemic accelerated implementation of remote evaluations. 

We describe the implementation of a multidisciplinary telemedicine approach for deep brain stimulation (DBS) pre-operative evaluations at an urban tertiary-care hospital.

Charts and billing records of movement disorder patients evaluated for DBS between 1/2019 – 3/2023 were retrospectively reviewed to capture demographic and disease information, insurance, distance from center, specialist and remote/in-person visit types, scheduling efficiency, and post-operative complication rates. Univariate analyses (chi-square, rank sum) were used.

243 patients were identified, n=107 with all in-person, n=37 with all telemedicine, and n=99 with mixed evaluations. Neuropsychology, psychiatry, and psychology evaluations were more often remote. A complete MDE occurred in n=115 (32.2% all telemedicine) and CM in n=190 (19.5% all telemedicine). Patients’ median distance from the center was 21 miles (IQR 10 – 48) and did not differ between telemedicine groups; 65% of individuals out-of-state were evaluated at least partially remotely. Age, gender, ethnicity, race, language, or insurance type did not differ between telemedicine groups. PD patients were most likely to have remote evaluation (OR 1.33), while dystonia patients were least likely (OR 0.45). Patients using telemedicine were less likely to have peri-operative complications (OR 0.23), while there was no effect of a CM. Median time to CM after complete MDEs (n=112) was 37 days (IQR 27 – 54) compared to incomplete MDEs (n = 78, median 49 days (IQR 28 – 90), p=0.03) and was unaffected by telemedicine (p=0.53 and 0.86 respectively). 

MDEs for DBS can be efficiently implemented including telemedicine. Completely remote MDEs prior to CMs do not hinder surgical safety.

Authors/Disclosures
Katharine Phillips
PRESENTER
Miss Phillips has nothing to disclose.
Christina Palmese No disclosure on file
Martijn Figee No disclosure on file
Shannon O'Neill, PhD (Mount Sinai West) Shannon O'Neill has nothing to disclose.
Brian Kopell No disclosure on file
Joohi Jimenez Shahed, MD (Icahn School of Medicine at Mount Sinai) Dr. Jimenez Shahed has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bracket Global LLC. Dr. Jimenez Shahed has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Teva. Dr. Jimenez Shahed has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alpha Omega. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for RegenXBio. Dr. Jimenez Shahed has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Praxis. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kyowa Kirin. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BlueRock Therapeutics. Dr. Jimenez Shahed has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for PhotoPharmics. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Emalex. The institution of Dr. Jimenez Shahed has received research support from Michael J Fox Foundation. The institution of Dr. Jimenez Shahed has received research support from Amneal. The institution of Dr. Jimenez Shahed has received research support from Annovis. The institution of Dr. Jimenez Shahed has received research support from SAGE. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Faculty with Movement Disorders Society. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Faculty with American Academy of Neurology. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Grant Reviewer with Parkinson Foundation. Dr. Jimenez Shahed has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant on Research Grant with Florida Atlantic University. Dr. Jimenez Shahed has received personal compensation in the range of $0-$499 for serving as a Speaker with Tourette Association of America. Dr. Jimenez Shahed has received personal compensation in the range of $5,000-$9,999 for serving as a Speaker with NACCME.