We describe the implementation of a multidisciplinary telemedicine approach for deep brain stimulation (DBS) pre-operative evaluations at an urban tertiary-care hospital.

Before 2019, pre-operative DBS evaluation at our center involved neurological, neuropsychological, and neurosurgical assessment. In late 2019, an expanded multidisciplinary evaluation (MDE; including psychiatry and psychology) and a systematically documented consensus meeting (CM) was phased in to assess DBS candidacy. The COVID-19 pandemic accelerated implementation of remote evaluations. 

Charts and billing records of movement disorder patients evaluated for DBS between 1/2019 – 3/2023 were retrospectively reviewed to capture demographic and disease information, insurance, distance from center, specialist and remote/in-person visit types, scheduling efficiency, and post-operative complication rates. Univariate analyses (chi-square, rank sum) were used.

243 patients were identified, n=107 with all in-person, n=37 with all telemedicine, and n=99 with mixed evaluations. Neuropsychology, psychiatry, and psychology evaluations were more often remote. A complete MDE occurred in n=115 (32.2% all telemedicine) and CM in n=190 (19.5% all telemedicine). Patients’ median distance from the center was 21 miles (IQR 10 – 48) and did not differ between telemedicine groups; 65% of individuals out-of-state were evaluated at least partially remotely. Age, gender, ethnicity, race, language, or insurance type did not differ between telemedicine groups. PD patients were most likely to have remote evaluation (OR 1.33), while dystonia patients were least likely (OR 0.45). Patients using telemedicine were less likely to have peri-operative complications (OR 0.23), while there was no effect of a CM. Median time to CM after complete MDEs (n=112) was 37 days (IQR 27 – 54) compared to incomplete MDEs (n = 78, median 49 days (IQR 28 – 90), p=0.03) and was unaffected by telemedicine (p=0.53 and 0.86 respectively). 

MDEs for DBS can be efficiently implemented including telemedicine. Completely remote MDEs prior to CMs do not hinder surgical safety.