Supplementary Material for: An International Survey of Deep Brain Stimulation Procedural Steps

<b><i>Background:</i></b> Deep brain stimulation (DBS) surgery is standard of care for the treatment of certain movement disorders. <b><i>Objective:</i></b> We sought to characterize the spectrum of steps performed in DBS surgery, at centers around the world where this surgery is performed. <b><i>Methods:</i></b> We identified the main steps in DBS surgery workflow and grouped these 19 steps into 3 phases (preoperative, operative, and postoperative). A survey tool, informed by a pilot survey, was administered internationally by trained study personnel at high- and low-volume DBS centers. Procedural components, duration, and surgeon motivational factors were assessed. Cluster analysis was used to identify procedural and behavioral clusters. <b><i>Results:</i></b> One hundred eighty-five procedure workflow surveys (143 DBS centers) and 65 online surveys of surgeon motivational drivers were completed (45% response rate). Significant heterogeneity in technique, operative time, and surgeon motivational drivers was reported across centers. <b><i>Conclusions:</i></b> We provide a description of the procedural steps involved in DBS surgery and the duration of these steps, based on an international survey. These data will enable individual surgeons and centers to examine their own experience relative to colleagues at other centers and in other countries. Such information could also be useful in comparing efficiencies and identifying workflow obstacles between different hospital environments

Supplementary Material for: Young Adults with Dyskinetic Cerebral Palsy Improve Subjectively on Pallidal Stimulation, but not in Formal Dystonia, Gait, Speech and Swallowing Testing

<p><b><i>Background:</i></b> Pharmacological treatment of dyskinetic cerebral palsy (CP) is often ineffective. Data about outcome of deep brain stimulation (DBS) in these patients remains scarce. <b><i>Methods:</i></b> Eight patients with dyskinetic CP and DBS of the Globus Pallidus internus were investigated. Using pre- and postoperative videos the severity of dystonia and changes thereof during standardized settings (‘on') and after the stimulator had been switched off (‘off') were assessed using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). Furthermore, subjective impression (SI) of the extent of postoperative change as well as gait (Leonardo Mechanograph® Gangway), speech (Frenchay Dysarthria) and swallowing performances (fiberoptic laryngoscopy) were assessed during ‘on' and ‘off'. <b><i>Results:</i></b> When comparing pre- and postoperative as well as ‘on' and ‘off', the BFMDRS and most of the gait, speech, and swallowing parameters did not differ significantly. In contrast, patients reported significant improvement of their SI postoperatively (3.1 on a 10-point-scale). <b><i>Conclusion:</i></b> Data show that our CP-patients did not benefit from GPi-DBS when tested formally for dystonia, gait, speech and swallowing. In stark contrast, these patients reported significant subjective improvement. Taken together, and in light of current unsatisfactory medical treatment options, our data suggest that further assessment of the effects of GPi-DBS in dyskinetic CP is warranted.</p