Deep Brain Stimulation Hardware Complications in Patients with Movement Disorders: Risk Factors and Clinical Correlations

Carvallo, José Fidel Baizabal; Mostile, Giovanni; Almaguer, Mike; Davidson, Anthony; Simpson, Richard K.; Jankovic, Joseph

doi:10.1159/000338222

Cited by 79 publications

(34 citation statements)

References 76 publications

(61 reference statements)

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“…However, DBS requires long-term management with battery replacement and the adjustment of stimulation parameters, and carries the risk of hardware-related problems such as infection, battery malfunction, lead migration and fracture [24]. The rates of these complications vary widely among previous studies (4.8-8.7%), but are considered acceptably low [25,26,27]. Thus, we suggest both thalamotomy and DBS for patients with focal hand dystonia.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Thalamotomy for Hairdresser's Dystonia: A Case Series

Horisawa

Goto²,

Nakajima³

et al. 2016

Stereotact Funct Neurosurg

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Background: Hairdresser's dystonia is a rarely reported form of focal hand dystonia, and the clinical course and treatment remains poorly understood. Objectives: The aim of this report was to clarify the impact of thalamotomy on hairdresser's dystonia. Methods: Four consecutive patients with hairdresser's task-specific dystonia evaluated at Tokyo Women's Medical University Hospital between 2008 and 2013 were treated with stereotactic thalamotomy, and were recruited for this case series. Results: The mean age at the onset of symptoms was 37.25 ± 10.64 years, the median duration of symptoms was 4.25 ± 1.3 years, and the mean follow-up period was 17 ± 12.37 months. Two of the 4 patients returned to work with significant improvement following the stereotactic thalamotomy and the beneficial effects persisted for the duration of their clinical follow-up. The other 2 patients experienced transient improvements for up to 3 months. Surgical complications included only dysarthria in 2 patients, and did not interfere with their daily activities. No patients experienced a deterioration of dystonic symptoms after thalamotomy. Conclusion: Although the benefits of thalamotomy remain vulnerable to incorrect or insufficient coagulation, stereotactic thalamotomy may be a feasible and effective procedure for patients with hairdresser's dystonia.

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Section: Discussionmentioning

confidence: 99%

Stereotactic Thalamotomy for Hairdresser's Dystonia: A Case Series

Horisawa

Goto²,

Nakajima³

et al. 2016

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

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“…1,5,14,17 Prior studies have used variable postoperative windows during which an infection can be attributed to DBS implantation. We used a postoperative window of 6 months to include more slowly evolving infections.…”

Section: Infection Risk In Imri Technique Versus Standard Dbs Techniquesmentioning

confidence: 99%

“…1,5 Recent studies have reported hardware infection rates ranging from 2% to 10% following conventional DBS surgery. 1,5,14,17,18 Utilization of the iMRI surgical approach has the potential to increase the rate of hardware infection, especially when performed in a diagnostic MRI suite that does not meet all the sterile characteristics of an operating room. We report our incidence of hardware infections from iMRI-guided DBS electrode implantations using a diagnostic MRI scanner in a radiology suite.…”

mentioning

confidence: 99%

Deep brain stimulator implantation in a diagnostic MRI suite: infection history over a 10-year period

Martin

Larson

Ziman

et al. 2017

JNS

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10,11,16 Precise electrode placement within a selected brain region is necessary to achieve efficacy, which is traditionally done with frame-based or "frameless" neuronavigation-guided stereotaxy supported by invasive physiological testing including microelectrode recording. Physiological methods can be used to mitigate the accuracy limitations of stereotactic methods that use a skull-mounted frame or other external markers for spatial registration of brain structures to preoperatively acquired images. 2The iMRI DBS electrode implantation technique utilizes bur hole-mounted trajectory guides oriented toward targets that are defined intraoperatively. The entire procedure is performed within the bore of an MR magnet, with the patient's head positioned at the rear magnet opening for surgical exposure and at the magnet isocenter for target identification, device alignment, and insertion monitoring. The primary benefits of the iMRI technique are high targeting accuracy, reduced operative time, and an ability to directly confirm electrode placement during the procedure. In contrast to conventional stereotactic methods, the iMRI approach is performed with the patient under general anesthesia and does not require intraoperative testing of motor symptoms. obJective The objective of this study was to assess the incidence of postoperative hardware infection following interventional (i)MRI-guided implantation of deep brain stimulation (DBS) electrodes in a diagnostic MRI scanner. methods A diagnostic 1.5-T MRI scanner was used over a 10-year period to implant DBS electrodes for movement disorders. The MRI suite did not meet operating room standards with respect to airflow and air filtration but was prepared and used with conventional sterile procedures by an experienced surgical team. Deep brain stimulation leads were implanted while the patient was in the magnet, and patients returned 1-3 weeks later to undergo placement of the implantable pulse generator (IPG) and extender wire in a conventional operating room. Surgical site infections requiring the removal of part or all of the DBS system within 6 months of implantation were scored as postoperative hardware infections in a prospective database. resUlts During the 10-year study period, the authors performed 164 iMRI-guided surgical procedures in which 272 electrodes were implanted. Patients ranged in age from 7 to 78 years, and an overall infection rate of 3.6% was found. Bacterial cultures indicated Staphylococcus epidermis (3 cases), methicillin-susceptible Staphylococcus aureus (2 cases), or Propionibacterium sp. (1 case). A change in sterile practice occurred after the first 10 patients, leading to a reduction in the infection rate to 2.6% (4 cases in 154 procedures) over the remainder of the procedures. Of the 4 infections in this patient subset, all occurred at the IPG site. conclUsions Interventional MRI-guided DBS implantation can be performed in a diagnostic MRI suite with an infection risk comparable to that reported for traditional surgical placement techniqu...

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“…Hardware complications: 25% of patients Paresthesias: 6%-36% Dysarthria: 3%-18% Ataxia: 6% Limb weakness: 4%-8% Balance disturbance: 3%-8% Dystonia: 2%-9% Perioperative complications (ie, intracerebral bleeding, ischemic stroke, infection) [152][153][154] The mortality rate of DBS surgery was found to be 0.4%. 155 There are only few controlled data for gamma knife thalamotomy.…”

Section: Surgical Treatment Options: Stereotactic Surgery and Gamma Kmentioning

confidence: 99%