Complications in subthalamic nucleus stimulation surgery for treatment of Parkinson’s disease. Review of 272 procedures

Seijo, F.; Álvarez-Vega, Marco; Gutiérrez, J.C. Galán; Fdez-Glez, F.; Lozano, Beatriz Rodríguez

doi:10.1007/s00701-007-1267-1

Cited by 137 publications

(87 citation statements)

References 33 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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“…1 A variety of complications have been described and can present at any time after the initial electrode placement. 6 DBS patients can present to the emergency department (ED) with infection, battery exhaustion, hardware failure, and the side effects of stimulation, which include stimulation-induced dyskinesias and behavioural problems. of increasingly aggressive behaviour over a 6-hour period.…”

Section: Ré Sumémentioning

confidence: 99%

“…Skin erosions occurring anywhere along the path of the DBS device 9 are often associated with infection and generally occur from 1 to 12 months postimplantation. 6 Hardware failure These types of malfunctions include battery failure, lead fracture and migration, and inadvertent switching off the INS unit. Most hardware failures are not emergencies and result in a patient's progressive return to pre-DBS symptoms.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Severe agitation following deep brain stimulation for parkinsonism

Rose

Mostrenko

McMaster

et al. 2011

CJEM

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The use of deep brain stimulation has become increasingly common for the treatment of movement disorders, including Parkinson disease. Although deep brain stimulation is generally very successful in alleviating the extrapyramidal symptoms of Parkinson disease, side effects can occur. This case report describes a patient presenting to the emergency department in a state of extreme aggression 3 days after a change in the parameters of his bilateral subthalamic nucleus stimulator. We review the complications of deep brain stimulation relevant to the emergency physician and provide some practical information on stimulator adjustment in an emergency. RÉ SUMÉIl est de plus en plus courant d'utiliser la stimulation cé ré brale profonde pour traiter les troubles du mouvement, y compris la maladie de Parkinson. Bien que cette technique donne gé né ralement de trè s bons ré sultats pour atté nuer les symptô mes extrapyramidaux de la maladie de Parkinson, des effets secondaires peuvent se produire. Nous pré sentons le cas d'un patient qui s'est pré senté à l'urgence dans un é tat d'extrê me agressivité trois jours aprè s un changement aux paramè tres des é lectrodes de stimulation bilaté rale du noyau sous-thalamique. Nous passons en revue les complications de la stimulation cé ré brale profonde pertinentes pour le mé decin d'urgence et fournissons de l'information pratique sur le ré glage du stimulateur en urgence.

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“…Several studies have focused on DBS complications (Benabid et al 2009;Hariz 2002;Joint et al 2002;Seijo et al 2007). …”

Section: Complicationsmentioning

confidence: 99%

High frequency deep brain stimulation of the subthalamic nucleus versus continuous subcutaneous apomorphine infusion therapy: a review

et al. 2010

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In advanced Parkinson's disease, several therapeutical option including not only lesional surgery (VIM, GPi) and deep brain stimulation (STN, GPi, VIM) but also continuous subcutaneous apomorphine infusion therapy can be proposed to the patient. The choice depends on the hope of the patient, patient's general health condition and the experience and choice of the neurosurgical and neurologist team. Here we report our experience based on 400 STN-DBS cases and we discuss, on the basis of our experience and on the literature, the advantage and disadvantage of DBS strategy as compared with non-surgical option such as continuous subcutaneous apomorphine infusion therapy.

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Complications in subthalamic nucleus stimulation surgery for treatment of Parkinson’s disease. Review of 272 procedures

Abstract: Deep brain stimulation surgery is an effective and safe method to treat Parkinson's disease with a low incidence of permanent adverse events.

Cited by 137 publications

References 33 publications

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

Severe agitation following deep brain stimulation for parkinsonism

High frequency deep brain stimulation of the subthalamic nucleus versus continuous subcutaneous apomorphine infusion therapy: a review

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