Deep brain stimulation: Postoperative issues

Abstract

Numerous factors need to be taken into account when managing a patient with Parkinson's disease (PD) after deep brain stimulation (DBS). Questions such as when to begin programming, how to conduct a programming screen, how to assess the effects of programming, and how to titrate stimulation and medication for each of the targeted sites need to be addressed. Follow-up care should be determined, including patient adjustments of stimulation, timing of follow-up visits and telephone contact with the patient, and stimulation and medication conditions during the follow-up assessments. A management plan for problems that can arise after DBS such as weight gain, dyskinesia, axial symptoms, speech dysfunction, muscle contractions, paresthesia, eyelid, ocular and visual disturbances, and behavioral and cognitive problems should be developed. Long-term complications such as infection or erosion, loss of effect, intermittent stimulation, tolerance, and pain or discomfort can develop and need to be managed. Other factors that need consideration are social and job-related factors, development of dementia, general medical issues, and lifestyle changes. This report from the Consensus on Deep Brain Stimulation for Parkinson's Disease, a project commissioned by the Congress of Neurological Surgeons and the Movement Disorder Society, outlines answers to a series of questions developed to address all aspects of DBS postoperative management and decision-making with a systematic overview of the literature (until mid-2004) and by the expert opinion of the authors. The report has been endorsed by the Scientific Issues Committee of the Movement Disorder Society and the American Society of Stereotactic and Functional Neurosurgery.

Negative impact of borderline global cognitive scores on quality of life after subthalamic nucleus stimulation in Parkinson's disease

“…But there might be additional individual factors such as subtle personality traits, social networks and family background, job-related issues but possibly also subtle differences of electrode location that were not investigated in the present study and might be also relevant for changes in QoL after STN-DBS. The benefit of STN-DBS on QoL is mostly driven by improvements in the PDQ-39 subscales "activities of daily living," "stigma," "emotional well-being" and "mobility" [20]. STN-DBS patients in the lowest quartile of the MDRS showed no significant improvement on these subscales compared to patients in the BMT group also scoring in the lowest quartile of the MDRS.…”

The Effect of Short Pulse Width Settings on the Therapeutic Window in Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s disease

“…However, the use of conventional programming parameters presents limitations in some patients due to the emergence of side effects at levels of stimulation required to counteract Parkinsonian motor symptoms (5)(6)(7)(8)(9).…”

Patient-specific models and simulations of deep brain stimulation for postoperative follow-up

“…In case 1, speech intelligibility was impaired when the 0.2 V/mm electric field isolevel, from active electrode contacts positioned ventral, posterior and medial to the centre of the STN, covered a major part of the fct. Stimulation-induced speech impairments during STN DBS has often been attributed to lateral stimulation of the motor limb in the internal capsula, the corticobulbar fibers [6]. During stimulation of the corticobulbar fibers there is usually a change of sustained phonation and other acoustical parameters.…”