Referrals for movement disorder surgery: Under-representation of females and reasons for refusal

Objective: Referral of movement disorder patients for deep brain stimulation surgery was examined to determine whether referred patients were representative of gender proportions in our population, and reasons why patients do not proceed to surgery. Methods: Demographic information on referrals to the surgical program was retrospectively reviewed from our database and from a detailed chart review. Results: Although almost equal numbers of movement disorder patients are male and female, of the 91 patients referred for surgery, only 31% were female. Sixty-one percent of referred patients did not undergo Surgery. Of these, the majority were denied for medical reasons, including cognitive decline (21 %), psychiatric concerns (5%) and neurological reasons (42%). Conclusions: Almost one-third of patients referred for movement disorder surgery were denied for medical reasons. This underscores the importance of evaluation of all potential patients by a multidisiplinary team to fully assess suitablity for stereotactic surgery. Interestingly, women were under-represented in those referred. In order that all appropriate patients have the opportunity to consider surgery, education of both physicians and patients, and different strategies to approach females regarding surgery may allow more patients to benefit from this treatment.