{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T10:06:45Z","timestamp":1782382005437,"version":"3.54.5"},"reference-count":34,"publisher":"Cambridge University Press (CUP)","issue":"2","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. J. Neurol. Sci."],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec id=\"S031716712500071X_as1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Movement disorders (Parkinson\u2019s disease, essential tremor, dystonia) are debilitating, progressive conditions that profoundly impact patients\u2019 quality of life. Surgical therapies, such as deep brain stimulation (DBS) can provide tremendous relief to patients but remain costly and, therefore, limited in availability. It is critical to understand regional barriers to accessing this service to improve access for all patients who may benefit from it.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S031716712500071X_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This is a mixed methods survey of stakeholders (patients\/family members, advocacy groups, family physicians, neurologists, neurosurgeons) assessing perceived barriers to DBS for movement disorders. Closed and open-ended questions were used. Descriptive statistics were used to highlight regions of Canada where perceived access is poor and to identify barriers to access.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S031716712500071X_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 220 responses were recorded (12 neurosurgeons, 22 neurologists, 30 family physicians, 153 patients and caregivers and 3 advocacy group personnel). Themes included limited resources\/centralization of resources, education, burdensome referral patterns and personal patient factors. Barriers included costs associated with travel, waitlists, lack of specific resources and poor understanding of movement disorders, DBS indications and referral pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S031716712500071X_as4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A number of barriers to access to DBS have been identified, related to geography and centralization of services, referrals and need for further education of indications and safety. The use of virtual care, centralized referral pathways and further research to determine the true prevalence of candidates for this therapy are required to improve access to DBS for movement disorders in Canada.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/cjn.2025.71","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T04:21:15Z","timestamp":1745814075000},"page":"226-244","source":"Crossref","is-referenced-by-count":1,"title":["Mixed Methods Survey to Identify Barriers to Accessing Deep Brain Stimulation for Movement Disorders in Canada"],"prefix":"10.1017","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2691-2692","authenticated-orcid":false,"given":"Melissa","family":"Lannon","sequence":"first","affiliation":[{"name":"McMaster University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Martyniuk","sequence":"additional","affiliation":[{"name":"McMaster University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minoo","family":"Aminnejad","sequence":"additional","affiliation":[{"name":"McMaster University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami","family":"Hatoum","sequence":"additional","affiliation":[{"name":"McMaster University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Paoloni","sequence":"additional","affiliation":[{"name":"McMaster University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devin","family":"Hall","sequence":"additional","affiliation":[{"name":"McMaster University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Forough","family":"Farrokhyar","sequence":"additional","affiliation":[{"name":"McMaster University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohit","family":"Bhandari","sequence":"additional","affiliation":[{"name":"McMaster University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suneil K.","family":"Kalia","sequence":"additional","affiliation":[{"name":"Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunjay","family":"Sharma","sequence":"additional","affiliation":[{"name":"McMaster University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,4,28]]},"reference":[{"key":"S031716712500071X_ref33","unstructured":"33. Canadian Medical Association. Number of Physicians by Province\/Territory and Specialty, Canada, 2019 [Internet]. 2019 [cited 2023 Oct 15]. Available from: https:\/\/www.cma.ca\/sites\/default\/files\/2019-11\/2019-01-spec-prov.pdf."},{"key":"S031716712500071X_ref26","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2011.151"},{"key":"S031716712500071X_ref6","first-page":"S632","article-title":"Cultural disparities in deep brain stimulation (DBS) decision making in patients with Parkinson\u2019s disease (PD): Updates","volume":"35","author":"Shirane","year":"2020","journal-title":"Mov Disord"},{"key":"S031716712500071X_ref21","first-page":"S359","article-title":"Underserved patient access to movement disorders care: experience from a tertiary academic referral center","volume":"35","author":"Giacobbe","year":"2020","journal-title":"Mov Disord"},{"key":"S031716712500071X_ref25","first-page":"100599","article-title":"Trends and disparities in deep brain stimulation utilization in the United States: a nationwide inpatient sample analysis from 1993 to 2017","volume":"26","author":"Sarica","year":"2023","journal-title":"Lancet Reg Health - Am"},{"key":"S031716712500071X_ref14","unstructured":"14. Pooja, S , Yen, K , Miyasaki, J , Shetty, A , Sankar, T , Ba, F. Ethnic and gender disparities in access to deep brain stimulation surgery for movement disorders in a Canadian center. In 2021."},{"key":"S031716712500071X_ref32","unstructured":"32. Statistics Canada. Canadian Community Health Survey (CCHS), Table 13-10-0113-01, Health characteristics, two-year period estimates [Internet]. 2018. Available from: https:\/\/www150.statcan.gc.ca\/t1\/tbl1\/en\/tv.action?pid=1310011301."},{"key":"S031716712500071X_ref34","doi-asserted-by":"publisher","DOI":"10.5688\/aj720243"},{"key":"S031716712500071X_ref5","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2023.1269401"},{"key":"S031716712500071X_ref29","doi-asserted-by":"publisher","DOI":"10.15586\/codonpublications.parkinsonsdisease.2018.ch8"},{"key":"S031716712500071X_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2021.10.096"},{"key":"S031716712500071X_ref11","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.90.15_supplement.P2.073"},{"key":"S031716712500071X_ref12","first-page":"e98","article-title":"Disparities in access to DBS surgery based on patient demographics from 2003 to 2013","volume":"21","author":"Gupta","year":"2018","journal-title":"Neuromodulation Conf 21st Annu Meet North Am Neuromodulation Soc"},{"key":"S031716712500071X_ref22","doi-asserted-by":"publisher","DOI":"10.1017\/cjn.2020.79"},{"key":"S031716712500071X_ref31","unstructured":"31. Statistics Canada. Canadian Community Health Survey (CCHS), Table 13-10-0096-01 Health Characteristics, annual estimates [Internet]. 2021. Available from: https:\/\/www150.statcan.gc.ca\/t1\/tbl1\/en\/tv.action?pid=1310009601."},{"key":"S031716712500071X_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2015.11.010"},{"key":"S031716712500071X_ref19","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.830196"},{"key":"S031716712500071X_ref10","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.90.15_supplement.P4.073"},{"key":"S031716712500071X_ref30","doi-asserted-by":"publisher","DOI":"10.25318\/1710000901-eng"},{"key":"S031716712500071X_ref4","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-018-0128-2"},{"key":"S031716712500071X_ref1","first-page":"s7","volume":"6","year":"1985","journal-title":"RSC"},{"key":"S031716712500071X_ref2","first-page":"e3314","article-title":"Challenges and solutions for functional neurosurgery in developing countries","volume":"10","author":"Fezeu","year":"2018","journal-title":"Cureus"},{"key":"S031716712500071X_ref8","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0000000000001880_338"},{"key":"S031716712500071X_ref23","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.62.8.noc40425"},{"key":"S031716712500071X_ref27","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-023-01318-y"},{"key":"S031716712500071X_ref24","doi-asserted-by":"publisher","DOI":"10.1017\/cjn.2018.268"},{"key":"S031716712500071X_ref15","doi-asserted-by":"publisher","DOI":"10.1038\/s41531-022-00305-y"},{"key":"S031716712500071X_ref3","first-page":"149","article-title":"Role of functional neurosurgery in improving patient outcomes in Epilepsy, movement disorders, and chronic pain","volume":"121","author":"Chen","year":"2024","journal-title":"Mo Med"},{"key":"S031716712500071X_ref20","doi-asserted-by":"publisher","DOI":"10.1002\/mdc3.12965"},{"key":"S031716712500071X_ref18","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2020.00162"},{"key":"S031716712500071X_ref7","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26378"},{"key":"S031716712500071X_ref17","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1403.2010.00278.x"},{"key":"S031716712500071X_ref28","unstructured":"28. KU Leuven. DBS Select. 2024 [cited 2024 Dec 16]. About DBS Select. Available from: https:\/\/www.dbsselect.com\/en\/about\/."},{"key":"S031716712500071X_ref13","first-page":"A546","article-title":"African-Americans with Parkinson\u2019s disease receive disproportionately fewer deep brain stimulators (DBS) regardless of access to neurological surgeons","volume":"119","author":"Chan","year":"2013","journal-title":"J Neurosurg"}],"container-title":["Canadian Journal of Neurological Sciences \/ Journal Canadien des Sciences Neurologiques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S031716712500071X","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T10:16:54Z","timestamp":1772792214000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S031716712500071X\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,28]]},"references-count":34,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["S031716712500071X"],"URL":"https:\/\/doi.org\/10.1017\/cjn.2025.71","relation":{},"ISSN":["0317-1671","2057-0155"],"issn-type":[{"value":"0317-1671","type":"print"},{"value":"2057-0155","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,28]]}}}