Malignant deep brain stimulator withdrawal syndrome

Azar, Jehad; Elinav, Hila; Safadi, Rifaat; Soliman, Mona

doi:10.1136/bcr-2018-229122

Cited by 26 publications

(20 citation statements)

References 23 publications

(21 reference statements)

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“…All patients with DBS who are due for battery replacement should be counseled about the need to check battery status with the patient-controlled programmer and to contact the treating neurologist if the programmer shows the elective replacement indicator or end-of-service status. In PD, long-standing STN-DBS (> 5 years), advanced disease (> 15 years), low-dose dopaminergic medications and older age are risk factors for DBS withdrawal syndrome and should be a high priority for battery replacement in the case of battery exhaustion [ 6 , 7 ]. Urgent battery replacement or troubleshooting hardware malfunction is a high priority in most patients but should be decided on an individual basis after discussing the risk of complications, exposure risk to COVID-19 for both patients and healthcare workers and the availability of resources during the pandemic.…”

Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation Battery Exhaustion during the COVID-19 Pandemic: Crisis within a Crisis

Holla

Neeraja

Surisetti

et al. 2020

JMD

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Objective The novel coronavirus disease (COVID-19) pandemic and public health measures to control it have resulted in unique challenges in the management of patients with deep brain stimulation (DBS). We report our experience with the management of acute worsening of symptoms due to battery exhaustion in 3 patients with DBS. Methods Patients with DBS for movement disorders who visited the emergency room due to battery exhaustion during the nationwide lockdown from April to May 2020 were included. Results Two patients with subthalamic nucleus-DBS for Parkinson’s disease (PD) and one with globus pallidus interna-DBS for generalized dystonia presented with acute worsening of symptoms due to battery exhaustion. Urgent battery replacement was performed in both patients with PD. The patient with generalized dystonia was managed with medication adjustment as he chose to defer battery replacement. Conclusion DBS battery replacement can be an emergency. Decisions regarding DBS battery replacement should be individualized during this COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation Battery Exhaustion during the COVID-19 Pandemic: Crisis within a Crisis

Holla

Neeraja

Surisetti

et al. 2020

JMD

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“…This should be on a case-by-case basis, but non-urgent elective procedures: percutaneous endoscopic gastrostomy (PEG) for Duodopa, focused ultrasound thalamotomy (FUT), and deep brain stimulation (DBS) should be postponed, if and whenever possible. However, implantable pulse generator (IPG) battery replacements should still be performed because of the risks of the neuroleptic malignant syndrome with sudden battery failure (41).…”

Section: Parkinson's Disease and Other Movement Disordersmentioning

confidence: 99%

Chronic Neurology in COVID-19 Era: Clinical Considerations and Recommendations From the REPROGRAM Consortium

et al. 2020

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† The COVID19 pandemic is causing an unprecedented public health crisis impacting healthcare systems, healthcare workers and communities. The COVID-19 Pandemic Health System REsilience PROGRAM (REPROGRAM) consortium is an international not-for-profit think-tank established to champion the safety of healthcare workers, policy development and advocacy for global pandemic preparedness and action Specialty section: This article was submitted to Dementia and Neurodegenerative Diseases, a section of the journal Frontiers in Neurology

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“…The syndrome has been associated with death [15]. The syndrome has only been reported in patients with bilateral STN DBS with at least 5 years of DBS therapy and more than 15 years of disease duration [16]. Additional risk factors include early age at disease onset, advanced symptoms at the time of initial surgery, and excellent DBS benefit leading to significant dopaminergic medication reduction [2].…”

Section: Parkinson's Diseasementioning

confidence: 99%

Recommendations for Deep Brain Stimulation Device Management During a Pandemic

Miocinovic

Ostrem

Okun

et al. 2020

JPD

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U n c o r r e c t e d A u t h o r P r o o f Journal of Parkinson's Disease xx (20xx) x-xxAbstract. Most medical centers are postponing elective procedures and deferring non-urgent clinic visits to conserve hospital resources and prevent spread of COVID-19. The pandemic crisis presents some unique challenges for patients currently being treated with deep brain stimulation (DBS). Movement disorder (Parkinson's disease, essential tremor, dystonia), neuropsychiatric disorder (obsessive compulsive disorder, Tourette syndrome, depression), and epilepsy patients can develop varying degrees of symptom worsening from interruption of therapy due to neurostimulator battery reaching end of life, device malfunction or infection. Urgent intervention to maintain or restore stimulation may be required for patients with Parkinson's disease who can develop a rare but potentially life-threatening complication known as DBS-withdrawal syndrome. Similarly, patients with generalized dystonia can develop status dystonicus, patients with obsessive compulsive disorder can become suicidal, and epilepsy patients can experience potentially life-threatening worsening of seizures as a result of therapy cessation. DBS system infection can require urgent, and rarely emergent surgery. Elective interventions including new implantations and initial programming should be postponed. For patients with existing DBS systems, the battery status and electrical integrity interrogation can now be performed using patient programmers, and employed through telemedicine visits or by phone consultations. The decision for replacement of the implantable pulse generator to prevent interruption of DBS therapy should be made on a case-by-case basis taking into consideration battery status and a patient's tolerance to potential therapy disruption. Scheduling of the procedures, however, depends heavily on the hospital system regulations and on triage procedures with respect to safety and resource utilization during the health crisis. U n c o r r e c t e d A u t h o r P r o o f 32The novel coronavirus (COVID-19) pandemic is 33 rapidly changing how we live and practice medicine 34 globally. Patients treated with deep brain stimula-35 tion (DBS) for movement disorders, neuropsychiatric 36 disorders, and epilepsy face unique challenges. High-37 lighted in this article are practical management 38 recommendations for DBS providers during COVID-39 19 pandemic. Since public health guidelines vary 40 across countries, states and local municipalities and 41 rapidly change, each medical center needs to be 42 nimble and develop strategies to care for patients 43 within the home setting. DBS practices range from 44 large, tertiary centers to community clinics and vary 45 widely in terms of workflow, resource availability, 46 and level of expertise available on site. We provide 47 general recommendations and workflow algorithm 48 that centers can modify and adopt quickly while 49 exercising compliance at multiple levels. This cri-50 sis highlights the challenge of postponing electiv...

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Malignant deep brain stimulator withdrawal syndrome

Cited by 26 publications

References 23 publications

Deep Brain Stimulation Battery Exhaustion during the COVID-19 Pandemic: Crisis within a Crisis

Deep Brain Stimulation Battery Exhaustion during the COVID-19 Pandemic: Crisis within a Crisis

Chronic Neurology in COVID-19 Era: Clinical Considerations and Recommendations From the REPROGRAM Consortium

Recommendations for Deep Brain Stimulation Device Management During a Pandemic

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