Adverse events in deep brain stimulation: A retrospective long-term analysis of neurological, psychiatric and other occurrences

Abstract

Background and objectiveThe extent to which deep brain stimulation (DBS) can improve quality of life may be perceived as a permanent trade-off between neurological improvements and complications of therapy, comorbidities, and disease progression.Patients and methodsWe retrospectively investigated 123 consecutive and non-preselected patients. Indications for DBS surgery were Parkinson's disease (82), dystonia (18), tremor of different etiology (21), Huntington's disease (1) and Gilles de la Tourette syndrome (1). AEs were defined as any untoward clinical occurrence, sign or patient complaint or unintended disease if related or unrelated to the surgical procedures, implanted devices or ongoing DBS therapy.ResultsOver a mean/median follow-up period of 4.7 years (578 patient-years) 433 AEs were recorded in 106 of 123 patients (86.2%). There was no mortality or persistent morbidity from the surgical procedure. All serious adverse events (SAEs) that occurred within 4 weeks of surgery were reversible. Neurological AEs (193 in 85 patients) and psychiatric AEs (78 in 48 patients) were documented most frequently. AEs in 4 patients (suicide under GPI stimulation, weight gain >20 kg, impairment of gait and speech, cognitive decline >2 years following surgery) were severe or worse, at least possibly related to DBS and non reversible. In PD 23.1% of the STN-stimulated patients experienced non-reversible (or unknown reversibility) AEs that were at least possibly related to DBS in the form of impaired speech or gait, depression, weight gain, cognitive disturbances or urinary incontinence (severity was mild or moderate in 15 of 18 patients). Age and Hoehn&Yahr stage of STN-simulated PD patients, but not preoperative motor impairment or response to levodopa, showed a weak correlation (r = 0.24 and 0.22, respectively) with the number of AEs.ConclusionsDBS-related AEs that were severe or worse and non-reversible were only observed in PD (4 of 82 patients; 4.9%), but not in other diseases. PD patients exhibited a significant risk for non-severe AEs most of which also represented preexisting and progressive axial and non-motor symptoms of PD. Mild gait and/or speech disturbances were rather frequent complaints under VIM stimulation. GPI stimulation for dystonia could be applied with negligible DBS-related side effects.

Pallidal lead placement in dystonia: leads of non-responders are contained within an anatomical range defined by responders

“…In our study, the average commissure-based lead location is slightly distant from the target reported by Reich et al with a more lateral electrode localization in the present study (x = 21.4 ± 1.5 mm vs. Reich et al 19.8 ± 1.8 mm) [15]. Programming in all of our dystonia patients was not limited by pyramidal side effects and none of our patients experienced speech or gait disturbances during long-term stimulation [20].…”

Long-term outcomes of deep brain stimulation in Parkinson disease

“…Addition made to clarify that the patients not referred to in the following had non-PD movement disorders] 82 of whom had PD, 5% of patients with PD had severe long-term adverse events, and 23% of the 78 patients who received STN DBS had non-reversible adverse events 48 .…”

Botulinum toxin for the treatment of hand tremor

“…Using a similar study design, the same authors performed incoBoNT-A injections in 28 patients (of 33 enrolled) with hand ET [25]. IncoBoNT-A were injected into a mean of 9 (range, [8][9][10][11][12][13][14] hand and forearm muscles (80-120 U). IncoBoNT-A treatment led to significant reduction of tremor (FTM tremor rating scale part B and the National Institute of Health Collaborative Genetic Criteria tremor score severity) at weeks 4 and 8 (p < 0.05).…”

“…Treatment of tremor with oral medications 2 of 10 often provides insufficient relief, especially when the tremor is severe, and is frequently associated with systemic side effects [10,11]. Deep brain stimulation (DBS) is a highly effective treatment for tremor in ET and PD, but is invasive and can be associated with stimulation-induced and long-term side effects [12,13]. Functional lesional neurosurgery, especially focused ultrasound, has garnered more interest recently in the treatment of tremor but this intervention is not readily available and is associated with potentially serious adverse effects, particularly when performed bilaterally [14][15][16].…”