Deep brain stimulation hardware-related complications and their management: A single-center retrospective analysis of 65 patients with various dystonic conditions

Sobstyl, Michał; Giziński, Jakub; Kmieć, Tomasz; Kupryjaniuk, Anna

doi:10.1016/j.jns.2019.116513

Cited by 5 publications

(5 citation statements)

References 47 publications

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“…[3][4][5] However, several studies have reported a high prevalence (11%-25.3%) of hardware-related complications associated with DBS surgery. [6][7][8][9] GPi ablation (pallidotomy) is an alternative surgical option for dystonia that is rarely used in most developed countries where DBS is widely available. The small cohort studies report the efficacies of pallidotomy and GPi-DBS for dystonia are comparable.…”

Section: Introductionmentioning

confidence: 99%

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Safety and efficacy of unilateral and bilateral pallidotomy for primary dystonia

Horisawa

Fukui

Takeda

et al. 2021

Ann Clin Transl Neurol

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Objective Ablation of the globus pallidus internus (pallidotomy) is an effective surgical intervention for dystonia. However, the current literature on the efficacy and safety of pallidotomy for dystonia is derived only from single‐case reports and small cohort studies. Methods We retrospectively analyzed patients with primary dystonia who underwent pallidotomy at our institution between 2014 and 2019. Neurological conditions were evaluated using the Burke‐Fahn‐Marsden Dystonia Rating Scale (BFMDRS, range: 0–120). We evaluated the total BFMDRS score and each subitem score (nine body regions) in the patients who underwent unilateral and bilateral pallidotomy before surgery and at last available follow‐up. Moreover, postoperative complications were analyzed. Results We found that 69 and 20 patients underwent unilateral and bilateral pallidotomy respectively. The mean age at dystonia onset was 40.4 ± 15.2 years. The mean clinical follow‐up period was 17.2 ± 11.6 months. Unilateral pallidotomy significantly improved the total BFMDRS score from 11.2 ± 14.7 preoperatively to 5.4 ± 7.6 at last available follow‐up (51.8% improvement, p < 0.001). Furthermore, there was a significant and independent improvement in all midline BFMDRS subitems, including eyes, mouth, speech/swallow, and neck, after unilateral pallidotomy. Bilateral pallidotomy significantly improved the total BFMDRS score from 14.6 ± 10.2 preoperatively to 3.8 ± 8.2 at last available follow‐up (74.0% improvement, p < 0.001). However, bilateral pallidotomy induced medically refractory parkinsonism (postural instability and gait disturbance) in five patients, dysarthria in three patients, and dysphagia in one patient. Interpretation Unilateral radiofrequency pallidotomy remains a viable treatment option for patients with some forms of dystonia. Bilateral pallidotomy cannot be recommended due to unacceptably high complication rates.

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Section: Introductionmentioning

confidence: 99%

“…Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is the most applied surgical treatment for dystonia and has been validated by numerous clinical studies 3–5 . However, several studies have reported a high prevalence (11%–25.3%) of hardware‐related complications associated with DBS surgery 6–9 …”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of unilateral and bilateral pallidotomy for primary dystonia

Horisawa

Fukui

Takeda

et al. 2021

Ann Clin Transl Neurol

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“…The overall infection rate of 6.6% fits squarely within the ranges reported in the literature, as does the site of infection with the majority occurring in the scalp or at IPG site. [1][2][3][4][5][6][7]10 A total of 37 patients required device explantation, 25 of whom had subsequent reimplantations. Twenty-two of these patients did not have recurrent infections; however, there were 3 cases of recurrent infection.…”

Section: Discussionmentioning

confidence: 99%

“…Infections are the most common complication of DBS system implantation and have been reported to be between 0% and 15% in most studies. [1][2][3][4] Multiple studies have reported a failure to effectively clear an infection when there is only partial removal of such systems. 5,6 However, there is almost no information regarding the incidence of reinfection after explantation of the entire system.The common treatment for infection is hardware removal, as well as 6 weeks of intravenous (IV) antibiotics and a period of observation for recrudescent infection, prior to reimplantation.…”

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confidence: 99%

Recrudescent infection after deep brain stimulator reimplantation

Moser

Chitta

O'Brien

et al. 2022

Journal of Neurosurgery

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OBJECTIVE The efficacy of deep brain stimulation (DBS) in treating the symptoms of movement disorders can be life changing for patients. Thus, the 5%–15% incidence of stimulator-related infection requiring removal of the device can be particularly disheartening. Although DBS system reimplantation is generally successful, this is not always the case. The literature is replete with publications describing the incidence of infection and the associated features. However, the literature is sparse in terms of information on the incidence of recurrent or recrudescent infection after system reimplantation. The goal of this paper was to evaluate factors leading to unsuccessful reimplantation of a DBS system following initial infection. METHODS Data were reviewed for all DBS procedures performed by one surgeon (K.L.H.) over 19 years including the infectious agent, location of infection, treatment regimen, and subsequent reimplantation of a DBS system and long-term outcome. RESULTS In this series of 558 patients who had undergone DBS surgery, 37 (6.6%) subsequently developed an infection. Infections with methicillin-sensitive Staphylococcus aureus, Enterobacter species, or coagulase-negative staphylococci were predominant. Four patients had cerebritis, one had meningitis, and the rest had soft tissue infections of the pocket or scalp. All had their entire DBS system explanted, followed by 4–6 weeks of intravenous antibiotics and surveillance for recrudescence for an additional period of at least 30 days. Twenty-five patients subsequently underwent DBS system reimplantation, and the procedure was successful in 22. Three of the 4 patients with cerebritis developed a subsequent wound infection after system reimplantation. None of the other 22 patients developed a recurrence. The odds ratio for developing a recurrent infection after cerebritis was 28.5 (95% CI 1.931–420.5, p = 0.007). CONCLUSIONS This study, the largest series of DBS system reimplantations following infection, demonstrated that most patients can have successful reimplantations without recurrent infection. However, patients who have had DBS-related cerebritis have a nearly 30-fold increased risk of developing reinfection after reimplantation. Alternative strategies for these patients are discussed.

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“…DBS has been approved by the US Food and Drug Administration as an effective therapy for PD since 2002, and since 2003 for the treatment of dystonia [1][2][3]. Nevertheless, DBS implantation is associated with the possibility of both minor and major complications due to the implanted system [4,5].…”

Section: Introductionmentioning

confidence: 99%

Battery for deep brain stimulation depletion in Parkinson’s Disease and dystonia patients — a systematic review

Przytuła¹,

Dulski

Sobstyl

et al. 2021

Neurol Neurochir Pol.

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Introduction. Deep brain stimulation (DBS) therapy for Parkinson's Disease (PD) and dystonia is associated with the possibility of both minor and major complications. One possible side effect is the depletion of implantable pulse generator (IPG) battery and the associated sudden recurrence of PD or dystonia symptoms, which can be potentially life-threatening. Delayed or postponed outpatient visits due to COVID -19 may be a risk factor of battery end-of-life consequences.Objective. To analyse the clinical outcomes in reported PD and dystonia patients treated with DBS, who, as a result of the sudden depletion of the neurostimulator battery, developed life-threatening symptoms.Materials and methods. The databases of PubMed, Scopus, EMBASE and Google Scholar were searched using pre-established criteria.Results. A total of 244 articles was found, of which 12 met the adopted criteria. Selected papers presented a total of 17 case reports of DBS-treated patients -11 with PD, and six with dystonia -who had depleted IPG batteries and due to rapid worsening of PD/dystonia symptoms required urgent hospital admission. IPG battery replacement was the only effective treatment in the majority of cases.Conclusions. IPG battery depletion can result in fatal outcomes. Sudden recurrence of PD or dystonia symptoms in patients treated by DBS can be potentially life-threatening, so scheduling the replacement of a discharged IPG battery should not be postponed. The COVID-19 pandemic should alert staff at emergency, neurology and movement disorders wards not to postpone the visits of patients with an implanted DBS system.

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Deep brain stimulation hardware-related complications and their management: A single-center retrospective analysis of 65 patients with various dystonic conditions

Cited by 5 publications

References 47 publications

Safety and efficacy of unilateral and bilateral pallidotomy for primary dystonia

Safety and efficacy of unilateral and bilateral pallidotomy for primary dystonia

Recrudescent infection after deep brain stimulator reimplantation

Battery for deep brain stimulation depletion in Parkinson’s Disease and dystonia patients — a systematic review

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