An Experimental Study of Deep Brain Stimulation Lead Fracture: Possible Fatigue Mechanisms and Prevention Approach

2014 ◽  
Vol 18 (4) ◽  
pp. 243-248 ◽  
Author(s):  
Changqing Jiang ◽  
Xiaolong Mo ◽  
Yantao Dong ◽  
Fangang Meng ◽  
Hongwei Hao ◽  
...  
Keyword(s):  
Experimental Study ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Lead Fracture ◽  
Prevention Approach ◽  
Deep Brain

Lateralized effect of pallidal stimulation on self-mutilation in Lesch-Nyhan disease

2014 ◽  
Vol 14 (6) ◽  
pp. 594-597 ◽  
Author(s):  
Taylor J. Abel ◽  
Brian D. Dalm ◽  
Andrew J. Grossbach ◽  
Adam W. Jackson ◽  
Teri Thomsen ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
The Self ◽  
Lead Fracture ◽  
Self Mutilation ◽  
Pallidal Stimulation ◽  
Generalized Dystonia ◽  
Hypoxanthine Guanine Phosphoribosyltransferase ◽  
Deep Brain

Lesch-Nyhan disease (LND) is an X-linked hereditary disorder caused by a deficiency of hypoxanthine-guanine phosphoribosyltransferase. This syndrome is characterized by hyperuricemia, self-mutilation, cognitive impairment, and movement disorders such as spasticity and dystonia. The authors describe the case of a 15-year-old boy who underwent bilateral placement of globus pallidus internus (GPi) deep brain stimulation (DBS) electrodes for the treatment of generalized dystonia. His self-mutilating behavior gradually disappeared several weeks after the start of GPi stimulation. The dystonia and self-mutilating behavior returned on the left side only after a right lead fracture. This case is the first reported instance of LND treated with DBS in which the stimulation was interrupted and the self-mutilation returned in a lateralized fashion. The findings indicate that the neurobehavioral aspect of LND is lateralized and that contralateral GPi stimulation is responsible for lateralized improvement in self-injurious behavior.

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

2007 ◽  
Vol 106 (4) ◽  
pp. 621-625 ◽  
Author(s):  
Christopher Kenney ◽  
Richard Simpson ◽  
Christine Hunter ◽  
William Ondo ◽  
Michael Almaguer ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Large Population ◽  
Lead Fracture ◽  
Device Implantation ◽  
Ischemic Attack ◽  
Vasovagal Response ◽  
Deep Brain

Object The object of this study was to assess the long-term safety of deep brain stimulation (DBS) in a large population of patients with a variety of movement disorders. Methods All patients treated with DBS at the authors' center between 1995 and 2005 were assessed for intraoperative, perioperative, and long-term adverse events (AEs). A total of 319 patients underwent DBS device implantation. Of these 319, 182 suffered from medically refractory Parkinson disease; the other patients had essential tremor (112 patients), dystonia (19 patients), and other hyperkinetic movement disorders (six patients). Intraoperative AEs were rare and included vasovagal response in eight patients (2.5%), syncope in four (1.2%), severe cough in three (0.9%), transient ischemic attack in one (0.3%), arrhythmia in one (0.3%), and confusion in one (0.3%). Perioperative AEs included headache in 48 patients (15.0%), confusion in 16 (5.0%), and hallucinations in nine (2.8%). Serious intraoperative/perioperative AEs included isolated seizure in four patients (1.2%), intracerebral hemorrhage in two patients (0.6%), intraventricular hemorrhage in two patients (0.6%), and a large subdural hematoma in one patient (0.3%). Persistent long-term complications of DBS surgery included dysarthria (4.0%), worsening gait (3.8%), cognitive dysfunction (4.0%), and infection (4.4%). Revisions were completed in 25 patients (7.8%) for the following reasons: loss of effect, lack of efficacy, infection, lead fracture, and lead migration. Hardware-related complications included 12 lead fractuxres and 10 lead migrations. Conclusions The authors conclude that in their 10-year experience, DBS has proven to be safe for the treatment of medically refractory movement disorders.

Subpectoral Implantation of Internal Pulse Generators for Deep Brain Stimulation: Technical Note for Improved Cosmetic Outcomes

2017 ◽  
Vol 13 (4) ◽  
pp. 529-534 ◽  
Author(s):  
Gabrielle A. White-Dzuro ◽  
Wendell Lake ◽  
Joseph S. Neimat
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Technical Note ◽  
Patient Comfort ◽  
Complication Rates ◽  
Subcutaneous Implantation ◽  
Pulse Generators ◽  
Lead Fracture ◽  
Cosmetic Outcomes ◽  
Deep Brain

Abstract BACKGROUND: Deep brain stimulation is increasingly used to treat a variety of disorders. As the prevalence of this technology increases, greater demands are placed on neurosurgical practitioners to improve cosmetic results, maximize patient comfort, and minimize complication rates. We have increasingly employed subpectoral implantation of internal pulse generators (IPGs) to improve patient satisfaction. OBJECTIVE: To determine the complication rates of subpectorally placed IPGs as compared to those placed in a subcutaneous location. METHODS: We reviewed a series of 301 patients from a single institution. Complication rates including infection, hematoma, and lead fracture were recorded. Rates were compared for subcutaneously and subpectorally located devices. RESULTS: Of the records reviewed, we found 301 patients who underwent 308 procedures for initial IPG implantation. Of these, 275 were subpectoral IPG implantation, 19 were infraclavicular subcutaneous implantation, and 14 were subcutaneous implantation in the abdomen. A total of 6 IPG pocket infections occurred, 2 subpectoral and 4 infraclavicular subcutaneous. Of the IPG infections, 2 of the infraclavicular subcutaneous devices had associated erosions. Two patients had their devices relocated from a subpectoral pocket to a subcutaneous pocket in the abdomen due to discomfort. Two patients in the subpectoral group suffered from hematoma requiring evacuation. Two patients in the infraclavicular subcutaneous group had lead fracture occur. CONCLUSIONS: Subpectoral implantation of deep brain stimulation IPGs is a viable alternative with a low complication rate. This technique may offer a lower rate of infection and wound erosion.

Nicht-medikamentöse Optionen zur Behandlung pharmakoresistenter Epilepsien

2018 ◽  
Vol 75 (7) ◽  
pp. 448-454
Author(s):  
Thomas Grunwald ◽  
Judith Kröll
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Tiefe Hirnstimulation ◽  
Ketogene Diät ◽  
Deep Brain

Zusammenfassung. Wenn mit den ersten beiden anfallspräventiven Medikamenten keine Anfallsfreiheit erzielt werden konnte, so ist die Wahrscheinlichkeit, dies mit anderen Medikamenten zu erreichen, nur noch ca. 10 %. Es sollte dann geprüft werden, warum eine Pharmakoresistenz besteht und ob ein epilepsiechirurgischer Eingriff zur Anfallsfreiheit führen kann. Ist eine solche Operation nicht möglich, so können palliative Verfahren wie die Vagus-Nerv-Stimulation (VNS) und die tiefe Hirnstimulation (Deep Brain Stimulation) in eine bessere Anfallskontrolle ermöglichen. Insbesondere bei schweren kindlichen Epilepsien stellt auch die ketogene Diät eine zu erwägende Option dar.

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