Deep brain stimulation: In Poland as in the Wild West

Professor, let's talk about patients with Parkinson's disease who are being treated with one of the treatments namely DBS, or deep brain stimulation. What are the obstacles currently faced by a patient who qualifies for DBS, but also by the neurologist who treats the patient?

The problem has been the same for many years. We do not have a clear system for qualifying and managing patients after these procedures. Despite the fact that I and the entire community have been revisiting this problem for years, we cannot get out of this vicious circle of impotence to reorganize the system of care. The system and the patient pathway are very important. For the procedure of deep brain stimulation, a patient with Parkinson's disease, also with other indications, must undergo a good qualification according to accepted standards in the neurology department. Today, this procedure as a guaranteed benefit does not formally require this pathway, with the result that patients are operated on without neurological consultation, without considering all the pros and cons, and without the basic prerequisite for implementing this therapy, i.e. using optimized drug therapy. What's more, after the surgery they are often left on their own and no one guides them. And such a stimulator, first of all, has to be turned on, and secondly, it has to be programmed. And this programming is time-consuming, requiring a lot of knowledge and precision of the expert who will do it. We have a group of trained people in Poland (perhaps a small one, but still) who can take care of this. But we also don't have much desire among young neurologists to deal with it, precisely because this work of theirs is unnamed, unpaid and does not fit into any organizational structures for this procedure. And the procedure is not cheap, which is why we thought that from the payer's (National Health Fund or Ministry of Health) point of view it was important to use it...