logos-1 DBS Patient Assessment
ASSESS YOUR PATIENT

The following questions were developed based on absolute criteria as defined by the expert panel, defined as minimum requirements for the consideration of DBS therapy.
Your answers are anonymous and we do not collect patients' personal information.
You will be able to download or email the report at the end of the two-step questionnaire.
Answering all the questions should take about 2 or 3 minutes.

Step 1: Absolute criteria (5)
Parkinson’s Disease for at least 4 years

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Presence of bradykinesia plus muscular rigidity and/or rest tremor

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Asymmetric onset

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Slowly progressive

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Lack of prominent dysautonomia

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Lack of cerebellar or pyramidal findings

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Documented response to dopaminergic medication

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Presence of bothersome disease-related symptoms and/or side effects

Presence of symptoms (on-off fluctuations and/or dyskinesias and/or tremor) having a substantial impact on the patient's quality of life.
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Motor improvement with dopaminergic medication or presence of medically refractory tremor
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Absence of medical conditions preventing surgery (e.g. terminal cancer, severe cardio-respiratory insufficiency)
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Absence of ongoing severe, medically-resistant neuropsychiatric diseases (e.g. severe depression, severe cognitive impairment)

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Severe memory loss with disorientation for time and often to place.

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Severe impairment in handling problems.

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Step 2: Relative criteria (9)
Age
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Disease duration (since onset of symptoms)
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Severity of symptoms during OFF-state

Presence of symptoms (on-off fluctuations and/ or dyskinesias and/or tremor) having a substantial impact on the patient's quality of life.
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Severity of dyskinesias

Presence of symptoms (on-off fluctuations and/ or dyskinesias and/or tremor) having a substantial impact on the patient's quality of life.
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Refractory tremor

Presence of symptoms (on-off fluctuations and/ or dyskinesias and/or tremor) having a substantial impact on the patient's quality of life.
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Presence of levodopa-unresponsive gait and balance abnormalities
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Cognitive impairment

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No/mild: Absence of cognitive impairment or clinically evident cognitive dysfunction with only minimal interference with the patient’s ability to carry out normal activities and social interactions.

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Moderate: Cognitive deficits interfere with, but do not preclude the patient’s ability to carry out normal activities and social interactions
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Non-motor side effects of anti-parkinsonian medication
Initial referral decision:
Would you refer this patient to a specialized center for DBS therapy evaluation?
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