Adverse Events Associated With Deep Brain Stimulation for Movement Disorders

Patel, Daxa; Walker, Harrison C.; Brooks, Rebekah; Omar, Nidal B.; Ditty, Benjamin J.; Guthrie, Barton L.

doi:10.1227/neu.0000000000000659

Cited by 68 publications

(64 citation statements)

References 46 publications

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“…Although stereotactic techniques combining preoperative image-based planning with intraoperative recording and test stimulation are well-developed, these approaches carry risks including intracranial hemorrhage (1–3% both symptomatic and asymptomatic with <1% symptomatic), seizures (~1%), leak of cerebrospinal fluid (1–2%), and infection (2–3%) (Videnovic and Metman, 2008; Patel et al, 2015). While rates of adverse events appear to be quite low, in reality, these rates have been shown to increase to ~5% when data are prospectively and systematically collected (Burdick et al, 2010).…”

Section: Development In Technology and Applicationmentioning

confidence: 99%

Proceedings of the Fourth Annual Deep Brain Stimulation Think Tank: A Review of Emerging Issues and Technologies

Deeb

Giordano

Rossi

et al. 2016

Front. Integr. Neurosci.

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This paper provides an overview of current progress in the technological advances and the use of deep brain stimulation (DBS) to treat neurological and neuropsychiatric disorders, as presented by participants of the Fourth Annual DBS Think Tank, which was convened in March 2016 in conjunction with the Center for Movement Disorders and Neurorestoration at the University of Florida, Gainesveille FL, USA. The Think Tank discussions first focused on policy and advocacy in DBS research and clinical practice, formation of registries, and issues involving the use of DBS in the treatment of Tourette Syndrome. Next, advances in the use of neuroimaging and electrochemical markers to enhance DBS specificity were addressed. Updates on ongoing use and developments of DBS for the treatment of Parkinson's disease, essential tremor, Alzheimer's disease, depression, post-traumatic stress disorder, obesity, addiction were presented, and progress toward innovation(s) in closed-loop applications were discussed. Each section of these proceedings provides updates and highlights of new information as presented at this year's international Think Tank, with a view toward current and near future advancement of the field.

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Section: Development In Technology and Applicationmentioning

confidence: 99%

Proceedings of the Fourth Annual Deep Brain Stimulation Think Tank: A Review of Emerging Issues and Technologies

Deeb

Giordano

Rossi

et al. 2016

Front. Integr. Neurosci.

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“…Several studies from academic centers have documented the rate of electrode revision for DBS surgery, with rates ranging from under 2% in the acute phase [6] to 12.4% at 7 years of follow-up [7], and with causes including poor initial placement [8,9], lead migration [8,10], hardware failure [9,11], and infection [12,13]. Yet the rate of revisions in the general neurosurgical community, outside of reported academic series, is unknown.…”

Section: Introductionmentioning

confidence: 99%

An unexpectedly high rate of revisions and removals in deep brain stimulation surgery: Analysis of multiple databases

Rolston

Englot

Starr

et al. 2016

Parkinsonism & Related Disorders

130

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Introduction Deep brain stimulation (DBS) is an established therapy for movement disorders, and is under active investigation for other neurologic and psychiatric indications. While many studies describe outcomes and complications related to stimulation therapies, the majority of these are from large academic centers, and results may differ from those in general neurosurgical practice. Methods Using data from both the Centers for Medicare and Medicaid Services (CMS) and the National Surgical Quality Improvement Program (NSQIP), we identified all DBS procedures related to primary placement, revision, or removal of intracranial electrodes. Cases of cortical stimulation and stimulation for epilepsy were excluded. Results Over 28,000 cases of DBS electrode placement, revision, and removal were identified during the years 2004–2013. In the Medicare dataset, 15.2% and of these procedures were for intracranial electrode revision or removal, compared to 34.0% in the NSQIP dataset. In NSQIP, significant predictors of revision and removal were decreased age (odds ratio (OR) of 0.96; 95% CI: 0.94, 0.98) and higher ASA classification (OR 2.41; 95% CI: 1.22, 4.75). Up to 48.5% of revisions may have been due to improper targeting or lack of therapeutic effect. Conclusion Data from multiple North American databases suggest that intracranial neurostimulation therapies have a rate of revision and removal higher than previously reported, between 15.2 and 34.0%. While there are many limitations to registry-based studies, there is a clear need to better track and understand the true prevalence and nature of such failures as they occur in the wider surgical community.

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“…The procedure can be performed safely; however, despite the low rates of overall adverse events, hardware infection remains a frequent complication of DBS, with a reported incidence of 1-15% [1,2,3,4,5,6,7]. Given the significant clinical benefits of DBS therapy, complete explantation is not always considered by the practitioner as a first step in the setting of infection.…”

Section: Introductionmentioning

confidence: 99%

Cost of Deep Brain Stimulation Infection Resulting in Explantation

Chen

Mirzadeh²,

Lambert³

et al. 2017

Stereotact Funct Neurosurg

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Background: Deep brain stimulation (DBS) hardware infection is a serious complication, often resulting in multiple hardware salvage attempts, hospitalizations, and long-term antibiotic therapy. Objectives: We aimed to quantify the costs of DBS hardware-related infections in patients undergoing eventual device explantation. Methods: Of 362 patients who underwent 530 electrode placements (1 January 2010 to 30 December 2014), 16 (4.4%) had at least 2 hardware salvage procedures. Most (n = 15 [93.8%]) required complete explantation due to recurrent infection. Financial data (itemized hospital and physician costs) were available for 13 patients and these were analyzed along with the demographic data. Results: Each patient underwent 1-5 salvage procedures (mean 2.5 ± 1.4; median 2). The mean total cost for a patient undergoing the median number of revisions (n = 2), device explantation, and subsequent reimplantation after infection clearance was USD 75,505; just over half this cost (54.2% [USD 40,960]) was attributable to reimplantation, and nearly one-third (28.9% [USD 21,816]) was attributable to hardware salvage procedures. Operating-room costs were the highest cost category for hardware revision and explantation. Medical and surgical supplies accounted for the highest reimplantation cost. Conclusions: DBS infection incurs significant health care costs associated with hardware salvage attempts, explantation, and reimplantation. The highest cost categories are operating-room services and medical and surgical supplies.

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Adverse Events Associated With Deep Brain Stimulation for Movement Disorders

Cited by 68 publications

References 46 publications

Proceedings of the Fourth Annual Deep Brain Stimulation Think Tank: A Review of Emerging Issues and Technologies

Proceedings of the Fourth Annual Deep Brain Stimulation Think Tank: A Review of Emerging Issues and Technologies

An unexpectedly high rate of revisions and removals in deep brain stimulation surgery: Analysis of multiple databases

Cost of Deep Brain Stimulation Infection Resulting in Explantation

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