June 17, 2026

@michaelokun

Why do some folks fail deep brain stimulation screening? Deep brain stimulation (DBS) candidacy screening refers to the process of determining whether the potential benefits of surgery outweigh the risks for a particular person. Patricia Graese and colleagues describe in a new paper in Movement Disorders Clinical Practice the largest multidisciplinary analysis to date examining why some folks with Parkinson's disease, essential tremor, and dystonia do not ultimately move forward with DBS surgery. Key points: - More than 1,700 patients underwent multidisciplinary DBS evaluation and 10.4% were ultimately denied or tabled for surgery. - Excessive cognitive risk was the most common reason for candidacy failure, accounting for more than 60% of cases. - Psychiatric concerns, unrealistic expectations, medical co-morbidities, diagnostic uncertainty, gait and balance issues, and swallowing concerns all contributed to screening failures. My take: This study highlights an important truth about DBS. Success begins long before the operating room. The multidisciplinary screening process is not designed to keep folks from receiving therapy. It is designed to identify who is most likely to benefit and who may be placed at unnecessary risk. One of the most important findings was that cognition emerged as the dominant factor influencing candidacy decisions. The data also reinforce the value of movement disorders neurologists, neuropsychologists, psychiatrists, rehabilitation specialists, and neurosurgeons all working together as a team. I am biased as an author so please make up your own mind. Here are 5 points that resonated w/ me: 1- Cognitive health remains one of the most important considerations when evaluating DBS candidacy. 2- Unrealistic expectations can be just as important as medical factors when determining whether surgery is appropriate. 3- Psychiatric symptoms should be identified and treated early because stabilization may reopen the door to future DBS consideration. 4- Multidisciplinary teams help uncover risks that may otherwise be missed and improve patient safety. 5- The goal of DBS screening is matching the therapy to the person.