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Essentially the criteria we look out for are Parkinson's patients we feel will greatly benefit from this. We are looking for patients who maybe have mobile fluctuations, meaning they have this “on-off” phenomenon. We want to make sure we do not treat patients with dementia because they do not respond as well to DBS and we want to exclude patients who have severe depression. Again, patients with depression should not have surgery until their depression is stable. So we eliminate those patients who aren't suitable.
Traditionally, we kind of set an age limit of 70 years old, meaning that beyond that we would say that maybe they should not get DBS because it might not be able to help. Over time we became more flexible with age limits, and have done DBS for patients in their mid to late 70s to help them. The amount of help DBS can give often diminishes as the patient ages.
Part of the care is the kind of protocol people use to treat Parkinson's Disease. I think some doctors might not be too familiar with DBS as a treatment, therefore if you are not too familiar with DBS, it is much harder to offer. Sometimes there are misconceptions on the risk. Some people think it's extremely risky, but I think it really depends on your surgeons. If your surgeon has done a lot of this procedure and does it routinely, I would say it is a relatively safe procedure.
This is again a very common question for people who are considering DBS, and if you are selected, we pick the participants very carefully. Usually, we achieve a very high success rate, meaning that they feel it is a very great help to them and they will even recommend it to their friends with Parkinson's disease. I think in terms of failure, taking in mind the complications we expect, there is a risk of serious complication about 1% and a risk of infection about 3%.
To feel anxiety before surgery is normal. I would be more concerned if my patients are not worried about having surgery and I make sure they fully understand what they are going through. And the most frequent thing is the idea of surgery, their concern on the surgery and what is around it and also some questions on recovery. What I do tell them is that this surgery, if you think about it, is quite minimally invasive. Just two thin small wires going into the brain, the opening in the skull is small and the battery itself will go under the skin.
Essentially, the main thing to consider is if you have insurance or not, some patients have insurance that can partially cover the cost and in Singapore, Medisave might pay for some of that as well. There are some factors looking at the cost of DBS, best to speak to the clinic.