Short-term and long-term safety of deep brain stimulation in the treatment of movement disorders

Kenney, C.; Simpson, Richard K.; Hunter, Christine; Ondo, William G.; Almaguer, Michael; Davidson, Anthony; Jankovic, Joseph

doi:10.3171/jns.2007.106.4.621

Cited by 190 publications

(118 citation statements)

References 39 publications

Supporting

Mentioning

107

Contrasting

Unclassified

Order By: Relevance

“…18 Other series have shown that hardware complications like lead fracture, infection, skin erosion, and cable connection failure occur in up to one-quarter of patients. 40 Okun et al 29 found suboptimally placed electrodes in 46%, inadequate follow-up programming in 17%, and suboptimal DBS parameters in 37% of the cases.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A meta-analysis of outcomes and complications of magnetic resonance–guided focused ultrasound in the treatment of essential tremor

Mohammed

Patra

Nanda

2018

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVEMagnetic resonance–guided focused ultrasound (MRgFUS) is a novel technique that uses high-intensity focused ultrasound to achieve target ablation. Like a lens focusing the sun’s rays, the ultrasound waves are focused to generate heat. This therapy combines the noninvasiveness of Gamma Knife thalamotomy and the real-time ablation of deep brain stimulation with acceptable complication rates. The aim of this study was to analyze the overall outcomes and complications of MRgFUS in the treatment of essential tremor (ET).METHODSA meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was made by searching PubMed, Cochrane library database, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Patients with the diagnosis of ET who were treated with MRgFUS were included in the study. The change in the Clinical Rating Scale for Tremor (CRST) score after treatment was analyzed. The improvement in disability was assessed with the Quality of Life in Essential Tremor Questionnaire (QUEST) score. The pooled data were analyzed by the DerSimonian-Laird random-effects model. Tests for bias and heterogeneity were performed.RESULTSNine studies with 160 patients who had ET were included in the meta-analysis. The ventral intermediate nucleus was the target in 8 of the studies. The cerebellothalamic tract was targeted in 1 study. There was 1 randomized controlled trial, 6 studies were retrospective, and 2 were prospective. The mean number of sonications given in various studies ranged from 11 ± 3.2 to 22.5 ± 7.5 (mean ± SD). The maximum delivered energy ranged from 10,320 ± 4537 to 14,497 ± 6695 Joules. The mean of peak temperature reached ranged from 53°C ± 2.3°C to 62.0°C ± 2.5°C. On meta-analysis with the random-effects model, the pooled percentage improvements in the CRST Total, CRST Part A, CRST Part C, and QUEST scores were 62.2%, 62.4%, 69.1%, and 46.5%, respectively. Dizziness was the most common in-procedure complication, occurring in 43.4%, followed by nausea and vomiting in 26.85% (pooled percentage). At 3 months, ataxia was the most common complication, occurring in 32.8%, followed by paresthesias in 25.1% of the patients. At 12 months posttreatment, the ataxia had significantly recovered and paresthesias became the most common persisting complication, at 15.3%.CONCLUSIONSThe MRgFUS therapy for ET significantly improves the CRST scores and improves the quality of life in patients with ET, with an acceptable complication rate. Therapy with MRgFUS is a promising frontier in functional neurosurgery.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Protein denaturation or coagulative necrosis occurs in the cells at a temperature of 56°C for 1 second. 18 Because sound produces an alternating rarefaction, this generates acoustic cavitation. The skull presents a high acoustic impedance to the ultrasound as it absorbs and reflects the waves.…”

mentioning

confidence: 99%

A meta-analysis of outcomes and complications of magnetic resonance–guided focused ultrasound in the treatment of essential tremor

Mohammed

Patra

Nanda

2018

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…Battery replacements were excluded as a cause of surgical revision, since they are not adverse events but expected occurrences related to the long-term use of the internal pulse generators (IPG) [14,15]. We also excluded patients with complications during the implantation surgery, and the immediate (≤2 weeks) postoperative period, as they have already been reviewed elsewhere [6]. Due to the retrospective nature of this study no IRB approval was required.…”

Section: Methodsmentioning

confidence: 99%

“…Although various intra- and postoperative complications have been described in patients treated with DBS [6,7,8,9] those associated with hardware malfunction or infection carry a higher morbidity [10,11] as they usually require surgical revision of the implants or device removal, compromising long-term benefits and increasing health-care costs [10,11,12,13]. …”

Section: Introductionmentioning

confidence: 99%

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

Carvallo

Mostile²,

Almaguer³

et al. 2012

Stereotact Funct Neurosurg

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…5,9,12,23,24,27,31,33,34 Most of these studies are retrospective analyses of a single institutional experience, limiting the ability to generalize conclusions owing to inherent selection bias. Previous multicenter studies also have inherent limitations given their focus on a particular region and the small number of centers.…”

mentioning

confidence: 99%

Predictors of unfavorable outcomes following deep brain stimulation for movement disorders and the effect of hospital case volume on outcomes: an analysis of 33, 642 patients across 234 US hospitals using the National (Nationwide) Inpatient Sample from 2002 to 2011

Kalakoti

Ahmed

Bollam

et al. 2015

FOC

View full text Add to dashboard Cite

OBJECT With limited data available on association of risk factors and effect of hospital case volume on outcomes following deep brain stimulation (DBS), the authors attempted to identify these associations using a large population-based database. METHODS The authors performed a retrospective cohort study involving patients who underwent DBS for 3 primary movement disorders: Parkinson’s disease, essential tremor, and dystonia from 2002 to 2011 using the National (Nationwide) Inpatient Sample (NIS) database. Using national estimates, the authors identified associations of patient demographics, clinical characteristics, and hospital characteristics on short-term postoperative outcomes following DBS. Additionally, effect of hospital volume on unfavorable outcomes was investigated. RESULTS Overall, 33, 642 patients underwent DBS for 3 primary movement disorders across 234 hospitals in the US. The mean age of the cohort was 63.42 ± 11.31 years and 36% of patients were female. The inpatients’ postoperative risks were 5.9% for unfavorable discharge, 10.2% for prolonged length of stay, 14.6% for high-end hospital charges, 0.5% for wound complications, 0.4% for cardiac complications, 1.8% for venous thromboembolism, and 5.5% for neurological complications, including those arising from an implanted nervous system device. Compared with low-volume centers, odds of having an unfavorable discharge, prolonged LOS, high-end hospital charges, wound, and cardiac complications were significantly lower in the high-volume and medium-volume centers. CONCLUSIONS The authors’ study provides individualized estimates of the risks of postoperative complications based on patient demographics and comorbidities and hospital characteristics, which could potentially be used as an adjunct for risk stratification for patients undergoing DBS.

show abstract

Short-term and long-term safety of deep brain stimulation in the treatment of movement disorders

Abstract: The authors conclude that in their 10-year experience, DBS has proven to be safe for the treatment of medically refractory movement disorders.

Cited by 190 publications

References 39 publications

A meta-analysis of outcomes and complications of magnetic resonance–guided focused ultrasound in the treatment of essential tremor

A meta-analysis of outcomes and complications of magnetic resonance–guided focused ultrasound in the treatment of essential tremor

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

Predictors of unfavorable outcomes following deep brain stimulation for movement disorders and the effect of hospital case volume on outcomes: an analysis of 33, 642 patients across 234 US hospitals using the National (Nationwide) Inpatient Sample from 2002 to 2011

Contact Info

Product

Resources

About