A case-based review of troubleshooting deep brain stimulator issues in movement and neuropsychiatric disorders

Okun, Michael S.; Rodríguez, Ramón; Foote, Kelly D.; Sudhyadhom, Atchar; Bova, Frank J.; Jacobson, Charles E.; Bello, Brian L.; Zeilman, Pamela; Fernández, Hubert H.

doi:10.1016/j.parkreldis.2008.01.001

Cited by 61 publications

(56 citation statements)

References 44 publications

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“…4,7,10,14,17,18,[20][21][22][23][24]27,28) Most are mild and transient, but some serious morbidity also occurs. The mortality rate during the first 30 postoperative days after stereotactic surgery was 0.4%, and the permanent surgical morbidity rate was 1%, mainly caused by ICH (2.2%) in a large series (1183 patients).…”

Section: Discussionmentioning

confidence: 99%

“…8) DBS is considered to cause less morbidity than ablative procedures, but is associated with a significant incidence of adverse effects. 4,7,10,14,17,18,[20][21][22][23][24]27,28) In this study, we retrospectively analyzed DBSrelated complications in a consecutive series of 180 patients who underwent bilateral STN-DBS to consider preventive methods.…”

Section: Introductionmentioning

confidence: 99%

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Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

Umemura

Oka

Yamamoto

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Subthalamic nucleus deep brain stimulation (STN-DBS) is effective for medically refractory Parkinson's disease. We retrospectively analyzed complications in 180 consecutive patients who underwent bilateral STN-DBS. Surgery-related complications were symptomatic intracerebral hemorrhage in 2, chronic subdural hematoma in 1, and transient deterioration of medication-induced psychosis in 2 patients. Device-related complications involved device infection in 5, skin erosion in 5, and implantable pulse generator malfunction in 2 patients. All of these patients required surgical repair. Surgery and device-related complications could be reduced with increased surgical experience and the introduction of new surgical equipment and technology. Treatment or stimulation-related complications were intractable dyskinesia/dystonia in 11, problematic dysarthria in 7, apraxia of eyelid opening (ALO) in 11, back pain in 10, and restless leg syndrome in 6 patients. Neuropsychiatric complications were transient mood changes in some, impulse control disorder in 2, severe depression related to excessive reduction of dopaminergic medications in 2, rapid progression of dementia in 1, and suicide attempts in 2 patients. Most complications were mild and transient. Dysarthria and ALO were the most frequent permanent sequelae after STN-DBS. Treatment-related adverse events may be caused not only by the effect of stimulation effect but also excessive reduction of dopaminergic medication, or progression of the disease. In conclusion, STN-DBS seems to be a relatively safe procedure. Although serious complications with permanent sequelae are rare, significant incidences of adverse effects occur. Physicians engaged in this treatment should have a comprehensive understanding of the probable complications and how to avoid them.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

Umemura

Oka

Yamamoto

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…A phenomenon called``tolerance'' or``habituation'' occurs in patients with pain or movement disorders following long-term neurostimulation therapy including MCS and deep brain stimulation. 17,19) The decrease in the number of c-Fos/GFAP-double-immunopositive cells and the mean area of astrocytes following 8 weeks may be related to the mechanisms of tolerance/habituation.…”

Section: Discussionmentioning

confidence: 99%

Chronological Changes in Astrocytes Induced by Chronic Electrical Sensorimotor Cortex Stimulation in Rats

Morishita

Yamashita

Katayama

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Motor cortex stimulation (MCS) is a treatment option for various disorders such as medically refractory pain, poststroke hemiplegia, and movement disorders. However, the exact mechanisms underlying its effects remain unknown. In this study, the effects of long-term chronic MCS were investigated by observing changes in astrocytes. A quadripolar stimulation electrode was implanted on the dura over the sensorimotor cortex of adult rats, and the cortex was continuously stimulated for 3 hours, 1 week, 4 weeks, and 8 weeks. Immunohistochemical staining of microglia (ionized calcium-binding adaptor molecule 1 [Iba1] staining) and astrocytes (glial fibrillary acidic protein [GFAP] staining), and neuronal degeneration histochemistry (Fluoro-Jade B staining) were carried out to investigate the morphological changes following long-term chronic MCS. Iba1 staining and Fluoro-Jade B staining showed no evidence of Iba1-positive microglial changes or neurodegeneration. Following continuous MCS, GFAPpositive astrocytes were enlarged and their number increased in the cortex and the thalamus of the stimulated hemisphere. These findings indicate that chronic electrical stimulation can continuously activate astrocytes and result in morphological and quantitative changes. These changes may be involved in the mechanisms underlying the neuroplasticity effect induced by MCS.

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“…Complications of DBS can be classified as those related to the surgical procedure such as ICH, infection, postoperative seizure and procedure abortion, and those related to the hardware such as electrode fracture or dislocation and device malfunction [8,15,18,20,21] . The postoperative mortality of DBS treatment was reported to be 0-1.8%, and the incidence of postoperative permanent neurological deficits was 0.6-6% [1,15,[21][22][23][24] .…”

Section: Discussionmentioning

confidence: 99%

Avoidance and Management of Surgical and Hardware-Related Complications of Deep Brain Stimulation

Hu¹,

Jiang²,

Zhou³

et al. 2010

Stereotact Funct Neurosurg

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Objective: Although deep brain stimulation (DBS) is nonablative, it may give rise to many complications. In order to identify and reduce factors contributing to the complications, we performed a retrospective analysis of patients who received DBS in our institution over a 9-year period from March 2000 to December 2008. Methods: Included in this study were 161 patients (85 male and 76 female). Data from these patients were collected and analyzed with respect to the complications and factors potentially related to these complications. Results: A total of 25 surgical and hardware-related complications occurred in 24 patients, including confusion in 11 cases (6.83%), asymptomatic intracranial hemorrhage in 1 case (0.62%), electrode misplacement in 2 cases (1.24%), infection of the subcutaneous pocket receiving the pulse generator in 1 case (0.62%), skin erosion in 2 cases (1.24%), pulse generator seroma formation in 6 cases (3.72%), and device malfunction in 1 case (0.62%). There was no permanent neurological deficit. Conclusion: Confusion is the most common complication in simultaneous bilateral DBS targeting the subthalamic nucleus, especially in patients with severe Parkinson’s disease. With increasing experience of surgeons, complete obedience to intraoperative surgical routines and reasonable application of the microelectrode recording technique, other complications could also be reduced.

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A case-based review of troubleshooting deep brain stimulator issues in movement and neuropsychiatric disorders

Cited by 61 publications

References 44 publications

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

Chronological Changes in Astrocytes Induced by Chronic Electrical Sensorimotor Cortex Stimulation in Rats

Avoidance and Management of Surgical and Hardware-Related Complications of Deep Brain Stimulation

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