Identification and management of deep brain stimulation intra- and postoperative urgencies and emergencies

Morishita, Takashi; Foote, Kelly D.; Burdick, Adam P.; Katayama, Yoichi; Yamamoto, Takamitsu; Frucht, Steven J.; Okun, Michael S.

doi:10.1016/j.parkreldis.2009.10.003

Cited by 73 publications

(51 citation statements)

References 71 publications

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“…Although the causes of electrode misplacement and migration are not entirely understood, some have proposed changes in the intracranial volume after surgery leading to electrode dislodgement while removing the guiding cannula [21], skull growth and violent head movements [20,22]. In our series, 3 patients seemed to have a misplacement related to poor frame calibration and meningioma was found to be the cause in one electrode migration, but in the majority of cases there was no apparent cause.…”

Section: Discussionmentioning

confidence: 75%

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

Carvallo

Mostile²,

Almaguer³

et al. 2012

Stereotact Funct Neurosurg

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Background: Deep brain stimulation (DBS) has proven to be an effective treatment for Parkinson’s disease (PD) and other movement disorders, but its usefulness is limited by complications related to the hardware. Methods: We reviewed the records of all our patients treated with DBS from January 1996 to August 2010 and analyzed those with hardware complications and reasons for surgical revision. Results: A total of 512 patients underwent 856 electrode implantations during the study period. A total of 297 (58%) patients had PD, 127 (24.8%) had essential tremor (ET), 40 (7.8%) had dystonia, and 48 (9.37%) had another movement disorder. The mean age at the first electrode implantation was 57.6 ± 14 years and patients were followed for a mean of 3.9 ± 2.8 years. A total of 44 patients (8.6%) had a hardware complication or system revision. Lead fracture was the most common complication and occurred in 13 (2.5%) patients, followed by infections (n = 10, 1.9%), electrode misplacement (n = 10, 1.9%), electrode migration (n = 9, 1.75%), and other complications (n = 2 , 0.39%). Patients with ET had a higher risk of hardware complications compared to those with PD, 13 vs. 7% (OR 2.03; p = 0.042). Conclusions: DBS is a safe intervention with a relatively low rate of hardware complications.

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Section: Discussionmentioning

confidence: 75%

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

Carvallo

Mostile²,

Almaguer³

et al. 2012

Stereotact Funct Neurosurg

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“…Morishita et al [32 ] have recently reviewed intraoperative and postoperative urgent and emergent DBS-associated complications and have provided recommendations for management. Intracranial hemorrhage, seizures, and venous air embolism are the important perioperative emergencies reported.…”

Section: Surgicalmentioning

confidence: 99%

Anesthesia for deep brain stimulation

Venkatraghavan

Manninen

2011

Current Opinion in Anaesthesiology

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“…DBS therapy is delivered by implanted electrodes and repeated anesthesia is not required, unlike for mECT. The risk of perioperative complications including infection, hemorrhage, and seizure is low (Cheng et al, 2015), however, off-target stimulation can result in serious neuropsychiatric symptoms (Morishita et al, 2010). An additional drawback of DBS is the need to periodically replace the battery of the implanted pulse generator.…”

Section: Introductionmentioning

confidence: 99%

High-Frequency Stimulation at the Subthalamic Nucleus Suppresses Excessive Self-Grooming in Autism-Like Mouse Models

Chang

Berges

Chung

et al. 2015

Neuropsychopharmacol

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Approximately one quarter of individuals with an autism spectrum disorder (ASD) display self-injurious behavior (SIB) ranging from head banging to self-directed biting and punching. Sometimes, these behaviors are extreme and unresponsive to pharmacological and behavioral therapies. We have found electroconvulsive therapy (ECT) can produce life-changing results, with more than 90% suppression of SIB frequency. However, these patients typically require frequent maintenance ECT (mECT), as often as every 5 days, to sustain the improvement gained during the acute course. Long-term consequences of such frequent mECT started as early as childhood in some cases are unknown. Accordingly, there is a need for alternative forms of chronic stimulation for these patients. To explore the feasibility of deep brain stimulation (DBS) for intractable SIB seen in some patients with an ASD, we utilized two genetically distinct mouse models demonstrating excessive self-grooming, namely the Viaat-Mecp2 − /y and Shank3B −/− lines, and administered high-frequency stimulation (HFS) via implanted electrodes at the subthalamic nucleus (STN-HFS). We found that STN-HFS significantly suppressed excessive selfgrooming in both genetic lines. Suppression occurs both acutely when stimulation is switched on, and persists for several days after HFS is stopped. This effect was not explained by a change in locomotor activity, which was unaffected by STN-HFS. Likewise, social interaction deficits were not corrected by STN-HFS. Our data show STN-HFS suppresses excessive self-grooming in two autism-like mouse models, raising the possibility DBS might be used to treat intractable SIB associated with ASDs. Further studies are required to explore the circuitry engaged by STN-HFS, as well as other potential stimulation sites. Such studies might also yield clues about pathways, which could be modulated by non-invasive stimulatory techniques.

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Identification and management of deep brain stimulation intra- and postoperative urgencies and emergencies

Cited by 73 publications

References 71 publications

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

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

Anesthesia for deep brain stimulation

High-Frequency Stimulation at the Subthalamic Nucleus Suppresses Excessive Self-Grooming in Autism-Like Mouse Models

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