Two cases of ischemia associated with subthalamic nucleus stimulator implantation for advanced Parkinson's disease

Novak, Kevin; Nénonéné, Emmanuel K.; Bernstein, Lisa; Vergenz, Sandra; Medalle, Gina; Prager, Jordan M.; Eller, Theodore W.; Cozzens, Jeffrey W.; Rezak, Michael

doi:10.1002/mds.20947

Cited by 24 publications

(14 citation statements)

References 20 publications

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“…Microelectrode recordings were made with Axon Guideline 3000A system (Fred Haer Corp., Bowdoin, Me., USA). Each track was reconstructed on a customdigitized atlas using a computer drawing program as previously described [21] . Right brain mapping was conducted first, using a 56° sagittal angle (up from the intercommissural line) and 10° coronal angle (away from the midsagittal plane) of microelectrode penetration into the brain.…”

Section: Methodsmentioning

confidence: 99%

Successful Bilateral Subthalamic Nucleus Stimulation for Segmental Dystonia after Unilateral Pallidotomy

Novak

Nénonéné

Bernstein

et al. 2007

Stereotact Funct Neurosurg

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Background: Several subcortical structures have been targeted for surgical treatment of dystonia, including motor thalamus, internal segment of globus pallidus (GPi), and more recently, the subthalamic nucleus (STN). Deep brain stimulation of GPi is currently the preferred surgical treatment, but it is unclear if targeting other structures would yield better results. Patients who have already had a pallidotomy yet continue to experience dystonic symptoms may be limited in further treatment options. Methods: A patient with medically intractable, segmental, early-onset, primary torsion dystonia presented for surgical consultation after exhausting nearly all treatment options. Medications, botulinum toxin injections, cervical denervation surgery, and left-sided pallidotomy failed to give adequate relief. The patient was implanted with STN stimulating leads bilaterally according to standard procedures. Results: The patient received a 36% improvement in dystonic symptoms as measured by several dystonia rating scales. These benefits persisted for 2 years after surgery despite several hardware-related complications, and the patient reported being very satisfied with the outcome. Conclusion: This result supports the efficacy of STN deep brain stimulation in dystonia patients, even those with prior pallidotomy.

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Section: Methodsmentioning

confidence: 99%

Successful Bilateral Subthalamic Nucleus Stimulation for Segmental Dystonia after Unilateral Pallidotomy

Novak

Nénonéné

Bernstein

et al. 2007

Stereotact Funct Neurosurg

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“…83 Binder et al 84 systematically studied the hemorrhagic risk of DBS electrode implantation by using CT or MR imaging in a series of 481 electrode implantations in the STN, ventrolateral thalamus, and GPi. Hematomas were observed in 16 patients, and these were symptomatic in 6 patients.…”

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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“…These authors showed that there was a significantly higher incidence of infarction in patients with preexisting vascular disease compared to that in patients with only risk factors for vascular disease. The 2 cases of surgically induced infarction of Novak et al [3] had small-vessel disease or preexisting areas of ischemia, supporting the belief that this condition may be a risk factor for intraoperative ischemic infarction.…”

Section: Discussionmentioning

confidence: 77%

“…The hypothesis that ischemia caused MER silence and that unexplained MER silence may indicate ischemia is supported in some reports [3,9] . However, MER silence is not reliable if the ischemia had not occurred by the time that the MER was performed.…”

Section: Discussionmentioning

confidence: 87%

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Cerebral Ischemia Related to Globus Pallidus Internus Stimulation for Cervical Dystonia

Kang

Kim

Chang³

2011

Stereotact Funct Neurosurg

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Background: Deep brain stimulation (DBS) is generally a safe and effective method to treat intractable movement disorders. However, complications of surgery have been reported, such as hemorrhage, infection and hardware failure. Objectives and Methods: We describe an unusual complication associated with DBS of the globus pallidus internus (GPi). The patient was a 34-year-old man with a 5-year history of progressive cervical dystonia that was unresponsive to medical treatment. He underwent bilateral DBS of the posteroventral GPi. After test stimulation, the patient developed left facial weakness, as well as dysarthria and hemiparesis of the left side. Magnetic resonance imaging showed a small infarct in the right posterior internal capsule. There was no misplacement of the microelectrode. Results and Conclusion: The authors present this unique case of cerebral infarction as a complication of DBS. The mechanism of ischemia is unclear. However, in this case, we had performed microstimulation with high amplitude in order to determine the adverse effects. This magnitude of electrical stimulation may have led to small-vessel vasospasm, which may have induced ischemia. Although ischemia after DBS surgery is seldom reported, cerebral ischemia may be a surgical complication after DBS implantation.

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Two cases of ischemia associated with subthalamic nucleus stimulator implantation for advanced Parkinson's disease

Cited by 24 publications

References 20 publications

Successful Bilateral Subthalamic Nucleus Stimulation for Segmental Dystonia after Unilateral Pallidotomy

Successful Bilateral Subthalamic Nucleus Stimulation for Segmental Dystonia after Unilateral Pallidotomy

Neuroimaging and Deep Brain Stimulation

Cerebral Ischemia Related to Globus Pallidus Internus Stimulation for Cervical Dystonia

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