Reducing Hardware-Related Complications of Deep Brain Stimulation

Constantoyannis, Constantine; Berk, Çağlar; Honey, Christopher R.; Mendez, Ivar; Brownstone, Robert M.

doi:10.1017/s0317167100003966

Cited by 126 publications

(95 citation statements)

References 22 publications

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“…It is also important to point out that DBS therapy in OCD and TRD is more expensive than treatment with BACI or BACA, due to the continuing costs of programming, hardware failure, and battery changes. 27 Although the complication rates of DBS therapy are likely to be less than those attributed to BACI and BACA, the reported complications are not insignificant 7,35 and include an infection rate of 6%, a short-term (24-month) hardware failure rate of 1.4%, 7 and a long-term failure rate of 26%. 20 Furthermore, DBS implantation precludes any future treatment with ECT.…”

Section: Discussionmentioning

confidence: 99%

Ablative neurosurgery for mental disorders: is there still a role in the 21st century? A personal perspective

Eljamel

2008

FOC

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ObjectThe author presents his personal perspective on ablative neurosurgical techniques used to perform bilateral anterior cingulotomy (BACI) and bilateral anterior capsulotomy (BACA) for ameliorating the symptoms of refractory obsessive-compulsive disorder (OCD) and treatment refractory depression (TRD). With depression predicted to be the second most common cause of disability in the world by the year 2020 and the birth of electric neurostimulation representing an attractive alternative treatment option for TRD and OCD, it is desirable to revisit the pros and cons of these treatment options.MethodsThe author reviewed the surgical methods and outcome (including neuroimaging findings) in all cases in which ablative neurosurgery was performed at Ninewells Hospital and Medical School over the last 2 decades.ResultsThe advantages of ablative procedures (BACI and BACA) from patients’ and psychiatrists’ perspectives are that the ablative procedures are one-off procedures that do not require lifelong commitment to program the stimulation devices, fix hardware failures, or change exhausted batteries. From the perspective of healthcare funding bodies, the relatively low cost of these treatments is an advantage. The main disadvantages of BACI and BACA are the perceived higher complication rates, the irreversibility of the surgical lesions, and the stigma associated with brain destruction in psychiatric patients that are still unpalatable in the community at large. However, some patients still choose a one-off procedure in preference to any other options presented to them.ConclusionsThere is still place for BACI and BACA in modern neurosurgery for mental disorders, at least in the short term for those who do not want to commit to lifelong device programming and maintenance.

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Section: Discussionmentioning

confidence: 99%

Ablative neurosurgery for mental disorders: is there still a role in the 21st century? A personal perspective

Eljamel

2008

FOC

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“…These complications have been prospectively studied in a series of 144 patients from 2 different Canadian centers. 87 Complications related to the DBS hardware were seen in 11 patients (7.6%). There were 2 lead fractures (1.4%) and 9 infections (6.2%).…”

Section: Postoperative Evaluation Of Complicationsmentioning

confidence: 99%

Neuroimaging and Deep Brain Stimulation

Dormont¹,

Seidenwurm²,

Galanaud³

et al. 2009

AJNR Am J Neuroradiol

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SUMMARY: Deep brain stimulation (DBS) is a new neurosurgical method principally used for the treatment of Parkinson disease (PD).Many new applications of DBS are under development, including the treatment of intractable psychiatric diseases. Brain imaging is used for the selection of patients for DBS, to localize the target nucleus, to detect complications, and to evaluate the final electrode contact position. In patients with implanted DBS systems, there is a risk of electrode heating when MR imaging is performed. This contraindicates MR imaging unless specific precautions are taken. Involvement of neuroradiologists in DBS procedures is essential to optimize presurgical evaluation, targeting, and postoperative anatomic results. The precision of the neuroradiologic correlation with anatomic data and clinical outcomes in DBS promises to yield significant basic science and clinical advances in the future. Chronic high-frequency stimulation of the ventral intermediate nucleus (VIM) of the thalamus was first described in the early 1990s by Benabid et al.1 These authors implanted chronic stimulating electrodes in the VIM connected to a subcutaneous pulse generator positioned in the thoracic region to treat disabling tremor in 26 patients with Parkinson disease (PD) and in 6 with essential tremor.1 They demonstrated the effectiveness of this technique and its ability to produce complete relief from tremor. Improvement was maintained for up to 29 months. This was the first clinical demonstration that chronic high-frequency stimulation of nuclei (deep brain stimulation [DBS]) could replace destructive lesion-producing functional neurosurgery such as thalamotomy. This new technique was reversible and led to a renaissance in functional neurosurgery.Next, the same team introduced bilateral DBS of the subthalamic nucleus (STN) in patients with disabling akineticrigid PD and severe motor fluctuations.2 This work extended data obtained in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine monkey model of PD showing that lesions and electric stimulation of the subthalamic nucleus reduced all of the major motor disturbances in this animal model. The results in patients with advanced PD were striking and were reproduced in many centers internationally. The US Food and Drug Administration approved the use of DBS for treatment of advanced PD with bilateral STN stimulation in 2002 and internal globus pallidus (GPi) stimulation in 2003. The main indication for DBS remains advanced PD, but numerous additional applications have been developed, ranging from dystonia to cluster headache, Tourette syndrome, and even psychiatric indications like obsessive-compulsive disorders (OCD) and major depression.DBS is a neurosurgical method, but the role of neuroimaging in successful DBS intervention is critical. Neuroimaging is used for the preoperative selection of patients who will have DBS and to localize the intended target nuclei. In the postoperative period, imaging detects complications that uncommonly accompany the procedure, confirms the pos...

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“…Of the 254 abstracts reviewed, ten articles were selected, providing data on 922 patients treated with DBS [1][2][3][4][5][6][7][8][9][10] . One study [1] did not report the number of leads implanted.…”

Section: Analysis Of Studies and Statisticsmentioning

confidence: 99%

Hardware-Related Complications of Deep Brain Stimulation: A Review of the Published Literature

Hamani

Lozano

2006

Stereotact Funct Neurosurg

196

108

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Hardware-related complications have been commonly described after deep brain stimulation. We searched the PubMed database using the key words ‘adverse effects’ and ‘deep brain stimulation’. Out of 254 studies, we identified 10 articles that primarily addressed morbidity and hardware-related adverse effects in 922 patients. The most commonly reported hardware-related complications were infections (6.1% of the patients), migration or misplacement of the leads (5.1% of the patients), lead fractures (5.0% of the patients), and skin erosion (1.3% of the patients). Refinements in surgical technique, technological improvements, and a greater experience with the procedures will likely decrease the incidence of hardware-related side effects in the future.

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Reducing Hardware-Related Complications of Deep Brain Stimulation

Cited by 126 publications

References 22 publications

Ablative neurosurgery for mental disorders: is there still a role in the 21st century? A personal perspective

Ablative neurosurgery for mental disorders: is there still a role in the 21st century? A personal perspective

Neuroimaging and Deep Brain Stimulation

Hardware-Related Complications of Deep Brain Stimulation: A Review of the Published Literature

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