North American Survey on the Effects of the COVID-19 Pandemic Shutdown on DBS Care

ABSTRACT

Objective: To evaluate the changes in multiple aspects of DBS care during onset of the COVID-19 shutdown. Background: During the initial COVID-19 shutdown, elective surgeries were cancelled in most U.S. and Canadian medical centers along with in-person office visits. On behalf of the Parkinson Study Group (PSG) this survey evaluated how deep brain stimulation (DBS) care at practices in North America was affected by the shutdown. Design/Methods: A RedCap ® survey supported by a UL1TR00142 grant was sent to all the members of the PSG Functional Neurosurgical Working Group. Survey responses were limited to one member per site and were collected from May 15-June 6, 2020. Results: Twenty three PSG sites (21 academic, 2 private practice) participated, including 19 (83%) sites in the USA and 4 (17%) in Canada. COVID-associated restrictions impacting DBS care were put in place lasting 4-16 weeks at various sites. A third of sites discontinued preoperative evaluations while the remaining offered limited preoperative evaluations. DBS practice changes affecting all aspects of care were reported, including preoperative assessments (96%), electrode placement (87%), new implantable pulse generator (IPG) placement (83%), IPG replacement (65%), initial DBS programming (74%), and routine DBS programming (91%). Though all sites reported institutional policy as a reason for practice change, 87% also reported patient-driven DBS surgery postponement due to COVID concerns. Conclusions: COVID-19 pandemic shutdowns resulted in restricted access to multiple phases of DBS care in almost all U.S. and Canadian sites in this large survey. While initial electrode and IPG implantation and initial programming can be deferred while continuing medical management, delays in IPG replacement (e.g., for a depleted battery or hardware failure) can result in potentially life-threatening consequences. This survey of real-world practice effects draws attention to the need for developing contingency plans for DBS care should pandemic shutdowns recur.