IS DBS THERAPY RIGHT FOR ME?

THANK YOU FOR TAKING THE TIME TO ASSESS YOUR SUITABILITY FOR DBS. THIS QUESTIONNAIRE SHOULD TAKE ABOUT 10 MINUTES TO COMPLETE. PLEASE FIND BELOW SOME GUIDANCE RELATED TO THE QUESTIONNAIRE BEFORE PROCEEDING.

BEFORE STARTING THE QUESTIONNAIRE:


Be aware that you can go back and change your answers at any point in the process.

Try to answer the questions for yourself, but you may want to ask someone who knows you well to comment on your responses.

Remember that once you leave the questionnaire your answers will not be saved, so make sure you print the results.

STEP 1. ABOUT YOU


How old are you?
Have you had Parkinson’s disease for at least 4 years?
How long have you had Parkinson’s?
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STEP 2. YOUR PARKINSON’S

Do you have symptoms which are bothersome to you i.e. interfering with your day-to-day activities?

Do you take dopaminergic treatment in a typical day? (e.g. Levodopa, Sinemet, Stalevo, Parcopa Co-careldopa, Co-beneldopa)?

Do you notice an improvement in your symptoms when you take your medication?


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STEP 3. YOUR MOTOR OR PHYSICAL SYMPTOMS

How would you rate symptoms that re-emerge before your next medication dose is due?

How would you describe any involuntary, incontrollable and unintended movements (dyskinesias) you experience which affect your daily activities?

How would you describe any tremor you experience that interferes with your quality of life?

Do you have trouble walking without a walking aid such as a stick or cane, even once you have taken your medication?

Do you feel stiff when you walk, rather like a robot walks, even if you have taken your medication?

Does it sometimes feel like your feet are stuck to the floor?

Have you had any falls in the last three months?


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STEP 4. YOUR NON-MOTOR OR NON-PHYSICAL SYMPTOMS

Do you have difficulty thinking clearly and/or problems with your memory or concentration?

Have you lost interest in things you would usually enjoy?

Do you sometimes feel life is hopeless?

Do you experience symptoms triggered by your Parkinson’s medication such as hallucinations, nausea, sleep problems, diarrhoea, dizziness, gambling, hyper-sexuality, hypomania?


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STEP 5. OTHER CONSIDERATIONS TO DISCUSS WITH YOUR NURSE OR DOCTOR

Is it getting harder to do what you want to do at home, at work and in your leisure time?

Do you avoid conversations or talking on the phone because of speech concerns?

Do you need to urinate frequently?

Do you experience constipation?

Do you have an increased interest in, or difficulty having sex?

In the morning, does it take more than 20 minutes for your medication to start working?

Use this space to make notes to help you remember any other points you would like to discuss with your doctor.
Something I want to tell my doctor today
Something I learned about DBS that I want to clarify with my doctor

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REPORT FOR MY PARKINSON’S CHECKUP

SUMMARY

Thank you for completing the questionnaire. Based on your answers it is unclear if DBS is a good option for you. Please discuss this assessment and your options with your doctor.
Thank you for completing the questionnaire. Based on your answers we recommend that you ask your doctor about DBS therapy.
Thank you for completing the questionnaire. Based on your answers we strongly recommend that you ask your doctor about DBS therapy.

NOTE TO THE DOCTOR

Your patient has prepared for today’s Parkinson’s checkup by completing a questionnaire about symptoms, side effects, and everyday challenges. The questions were developed jointly by movement disorder specialists, people with Parkinson’s, the European Parkinson’s Disease Association (EPDA) and Medtronic. This report is intended to be a starting point for your further questions and patient evaluation.
SAVE REPORT AS A PDF

WANT MORE INFORMATION ON HOW TO USE THESE RESULTS IN YOUR NEXT VISIT?

CHECKUP TIPS

  • When you give the report to your doctor, explain that you used an online questionnaire to help you prepare for your appointment. Highlight key aspects that are important to you when discussing the report with your doctor

  • If you can, take someone with you to add further information, be another pair of ears, and to make notes

  • Take information about all your medications. Take the bottles or boxes with you if that helps

  • If you have been keeping a medication diary with details of how medication affects your symptoms, then take this to share with your doctor

  • Complete the questionnaire again for future appointments and compare the results over time.
Information on this site should not be used as a substitute for talking with your doctor. Always talk with your doctor about diagnosis and treatment information.

FIND PARKINSON’S ORGANISATIONS

Many organisations provide resources to people with Parkinson's and their families. The websites below provide helpful information, support, and the chance to get involved in activities and advocacy. Many organisations do provide Support Meetings for people with Parkinson’s regularly during the year. Please visit their websites for more information.

PARKINSON’S UK

NATIONAL UK PARKINSON FOUNDATION

EUROPEAN PARKINSON’S DISEASE ASSOCIATION

THE PARKINSON’S ALLIANCE


PARKINSON’S TREATMENT INFORMATION

You and your doctor may discuss different treatment options such as deep brain stimulation.
Let your doctor explain the benefits and risks and important safety information Medtronic DBS therapy is not for everyone. Not everyone will receive the same results.