Diagnosis and treatment of complications related to deep brain stimulation hardware

Abstract

Deep brain stimulation is a therapeutic technique increasingly used in the treatment of a variety of neurological, psychiatric, and pain disorders. Although beneficial, it carries the immediate and long-term risks associated with implanted hardware in the brain parenchyma and subcutaneous tissue. The most common hardware complications include electrode migrations or misplacements, wire fractures, skin erosion, infections, and device malfunction. We systematically reviewed the literature on deep brain stimulation-related complications and propose a diagnostic and therapeutic algorithm. Our aim is to provide a guide for clinicians and medical staff involved in the treatment of patients with deep brain stimulation for rapid recognition and efficient management of these complications.

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

“…This may also explain why in our study the proportion of lead fractures was significantly higher in patients with VIM DBS (usually indicated for ET) compared to STN DBS. These results, however, should be interpreted with caution as these differences have not been reported in previous studies and the multivariate analysis did not show any difference in complication rate with respect to the underlying disorder; therefore an independent effect of the underlying diagnosis to the different hardware complications was not confirmed in our study [10]. We were not able to demonstrate dystonia as a risk factor for hardware complications or lead fractures, as suggested by other authors [18].…”

“…Fractures may occur at different levels, but they tend to occur usually where the electrode enters the connection cable [10,11,12,13,26]. In our study, only 1 patient had a history of severe trauma preceding lead damage; to our knowledge no study has demonstrated that trauma is significantly associated with lead fractures [26,27].…”

“…We were not able to demonstrate dystonia as a risk factor for hardware complications or lead fractures, as suggested by other authors [18]. Of all the observed complications, 30 (68%) presented within the first 7 years of the study period without predominance of any specific complication, suggesting a ‘learning curve’ effect [10,11]. …”

“…In our study, 44 of 512 (8.6%) patients had some sort of hardware-related complication; lead fracture was the most common, noted in 2.5% of patients, followed by infections (1.9%) and misplacements (1.9%). The reported complication rates vary widely depending on definitions, methods of ascertainment, compliance and other factors [10], but our findings are consistent with those of a meta-analysis of ten studies assessing hardware issues in 922 patients, which found the following rates of complications: infections in 6.1% of the patients; migrations or misplacement in 5.5%, and lead fractures in 5.0% [13]. Another meta-analysis, involving 1,154 patients with PD and STN or GPi DBS, revealed an 8.7% of total frequency of hardware-related complications and 2.4% frequency of infections, rates very similar to those found in our population of DBS patients [17].…”

“…Although various intra- and postoperative complications have been described in patients treated with DBS [6,7,8,9] those associated with hardware malfunction or infection carry a higher morbidity [10,11] as they usually require surgical revision of the implants or device removal, compromising long-term benefits and increasing health-care costs [10,11,12,13]. …”