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Vol. 89, No. 2, 2011
Issue release date: April 2011

Long-Term Surgical and Hardware-Related Complications of Deep Brain Stimulation

Doshi P.K.
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Abstract

Objective: To evaluate the incidence of surgical and hardware-associated complications of deep brain stimulation (DBS) for a range of movement disorders. Methods: The study design is a retrospective analysis and review of surgical and hardware complications of DBS performed by a single surgeon from 1999 to 2009. A total of 153 cases of DBS (298 electrodes) for various movement disorders and a minimum follow-up of 1 year have been included. Two patients could not be implanted. A further 54 patients who underwent change of the implantable pulse generator (IPG) have been included for analysis of hardware-related complications. Results: The mean follow-up was 64 ± 36.15 (range = 12–129) months for the DBS group. Twenty-four (15.6%) patients developed complications. Confusion occurred in 3.9%, vasovagal attack in 1.9%, lead migration/misplaced lead in 2.5%, erosion and infection in 4.5% and IPG malfunction occurred in 1.4% of the patients. When calculated with respect to the number of electrodes and IPG replacements, the complication rate was lower (11.9%). Three patients had their system explanted, two of them being patients with dystonia who had inadvertently damaged their operative site. Conclusion: DBS surgery is a relatively safe surgery, with most of the complications being minor, without long-term morbidity. The complication rate in elderly (age ≧65 years) is comparable to that in younger patients. However, confusion is more frequent in this age group, and patients and relatives can be prepared to accept this as a transient morbidity.



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References

  1. Hariz MI: Complications of deep brain stimulation surgery. Mov Disord 2002;17(suppl 3):S162–S166.
  2. Beric A, Kelly PJ, Rezai A, Sterio D, Mogilner A, Zonenshayn M, Kopell B: Complications of deep brain stimulation surgery. Stereotact Funct Neurosurg 2001;77:73–78.
  3. Blomstedt P, Hariz MI: Hardware-related complications of deep brain stimulation: a ten year experience. Acta Neurochir (Wien) 2005;147:1061–1064; discussion 4.
  4. Joint C, Nandi D, Parkin S, Gregory R, Aziz T: Hardware-related problems of deep brain stimulation. Mov Disord2002;17(suppl 3): S175–S180.
  5. Kondziolka D, Whiting D, Germanwala A, Oh M: Hardware-related complications after placement of thalamic deep brain stimulator systems. Stereotact Funct Neurosurg 2002;79:228–233.
  6. Hu X, Jiang X, Zhou X, Liang J, Wang L, Cao Y, Liu J, Jin A, Yang P: Avoidance and management of surgical and hardware-related complications of deep brain stimulation. Stereotact Funct Neurosurg 2010;88:296–303.
  7. Chan DT, Zhu XL, Yeung JH, Mok VC, Wong E, Lau C, Wong R, Poon WS: Complications of deep brain stimulation: a collective review. Asian J Surg 2009;32:258–263.
  8. Da Costa A, Kirkorian G, Cucherat M, Delahaye F, Chevalier P, Cerisier A, Isaaz K, Touboul P: Antibiotic prophylaxis for permanent pacemaker implantation: a meta-analysis. Circulation 1998;97:1796–1801.
  9. Kenney C, Simpson R, Hunter C, Ondo W, Almaguer M, Davidson A, Jankovic J: Short-term and long-term safety of deep brain stimulation in the treatment of movement disorders. J Neurosurg 2007;106:621–625.
  10. Voges J, Waerzeggers Y, Maarouf M, Lehrke R, Koulousakis A, Lenartz D, Sturm V: Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery – experiences from a single centre. J Neurol Neurosurg Psychiatry 2006;77:868–872.
  11. Umemura A, Jaggi JL, Hurtig HI, Siderowf AD, Colcher A, Stern MB, Baltuch GH: Deep brain stimulation for movement disorders: morbidity and mortality in 109 patients. J Neurosurg 2003;98:779–784.
  12. Limousin P, Speelman JD, Gielen F, Janssens M: Multicentre European study of thalamic stimulation in parkinsonian and essential tremor. J Neurol Neurosurg Psychiatry 1999;66:289–296.
  13. Lyons KE, Wilkinson SB, Overman J, Pahwa R: Surgical and hardware complications of subthalamic stimulation: a series of 160 procedures. Neurology 2004;63:612–616.
  14. Seijo FJ, Alvarez-Vega MA, Gutierrez JC, Fdez-Glez F, Lozano B: Complications in subthalamic nucleus stimulation surgery for treatment of Parkinson’s disease: review of 272 procedures. Acta Neurochir (Wien) 2007;149:867–875; discussion 876.
  15. Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, Koudsie A, Limousin PD, Benazzouz A, LeBas JF, Benabid AL, Pollak P: Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 2003;349:1925–1934.
  16. Goodman RR, Kim B, McClelland S 3rd, Senatus PB, Winfield LM, Pullman SL, Yu Q, Ford B, McKhann GM 2nd: Operative techniques and morbidity with subthalamic nucleus deep brain stimulation in 100 consecutive patients with advanced Parkinson’s disease. J Neurol Neurosurg Psychiatry 2006;77:12–17.
  17. Kumar R, Lozano AM, Kim YJ, Hutchison WD, Sime E, Halket E, Lang AE: Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson’s disease. Neurology 1998;51:850–855.
  18. Tamma F, Rampini P, Egidi M, Caputo E, Locatelli M, Pesenti A, Chiesa V, Ardolino G, Foffani G, Meda B, Pellegrini M, Priori A: Deep brain stimulation for Parkinson’s disease: the experience of the Policlinico-San Paolo Group in Milan. Neurol Sci 2003;24(suppl 1):S41–S42.
  19. Levy RM, Lamb S, Adams JE: Treatment of chronic pain by deep brain stimulation: long term follow-up and review of the literature. Neurosurgery 1987;21:885–893.
  20. Benabid AL, Krack PP, Benazzouz A, Limousin P, Koudsie A, Pollak P: Deep brain stimulation of the subthalamic nucleus for Parkinson’s disease: methodologic aspects and clinical criteria. Neurology 2000;55(12 suppl 6): S40–S44.
  21. Deep-Brain Stimulation for Parkinson’s Disease Study Group: Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease. N Engl J Med 2001;345:956–963.
  22. Hamani C, Richter E, Schwalb JM, Lozano AM: Bilateral subthalamic nucleus stimulation for Parkinson’s disease: a systematic review of the clinical literature. Neurosurgery 2005;56:1313–1321; discussion 21–24.
  23. Hariz MI, Fodstad H: Do microelectrode techniques increase accuracy or decrease risks in pallidotomy and deep brain stimulation? A critical review of the literature. Stereotact Funct Neurosurg 1999;72:157–169.
  24. Xiaowu H, Xiufeng J, Xiaoping Z, Bin H, Laixing W, Yiqun C, Jinchuan L, Aiguo J, Jianmin L: Risks of intracranial hemorrhage in patients with Parkinson’s disease receiving deep brain stimulation and ablation. Parkinsonism Relat Disord 2010;16:96–100.
  25. Oh MY, Abosch A, Kim SH, Lang AE, Lozano AM: Long-term hardware-related complications of deep brain stimulation. Neurosurgery 2002;50:1268–1274; discussion 74–76.
  26. Takubo H, Harada T, Hashimoto T, Inaba Y, Kanazawa I, Kuno S, Mizuno Y, Mizuta E, Murata M, Nagatsu T, Nakamura S, Yanagisawa N, Narabayashi H: A collaborative study on the malignant syndrome in Parkinson’s disease and related disorders. Parkinsonism Relat Disord 2003;9(suppl 1):S31–S41.
  27. Thomas A, Iacono D, Luciano AL, Armellino K, Onofrj M: Acute akinesia or akinetic crisis in Parkinson’s disease. Neurol Sci 2003;24:219–220.
  28. Derost PP, Ouchchane L, Morand D, Ulla M, Llorca PM, Barget M, Debilly B, Lemaire JJ, Durif F: Is DBS-STN appropriate to treat severe Parkinson disease in an elderly population? Neurology 2007;68:1345–1355.
  29. Vesper J, Haak S, Ostertag C, Nikkhah G: Subthalamic nucleus deep brain stimulation in elderly patients – analysis of outcome and complications. BMC Neurol 2007;7:7.


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