Surgical Replacement of Implantable Pulse Generators in Deep Brain Stimulation: Adverse Events and Risk Factors in a Multicenter Cohort

2016 ◽  
Vol 94 (4) ◽  
pp. 235-239 ◽  
Author(s):  
Anders Fytagoridis ◽  
Tomas Heard ◽  
Jennifer Samuelsson ◽  
Peter Zsigmond ◽  
Elena Jiltsova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Brain Stimulation ◽  
Adverse Events ◽  
Brain Stimulation ◽  
Pulse Generators ◽  
Multicenter Cohort ◽  
Deep Brain

Reoperation for device infection and erosion following deep brain stimulation implantable pulse generator placement

2020 ◽  
Vol 133 (2) ◽  
pp. 403-410 ◽  
Author(s):  
Travis J. Atchley ◽  
Nicholas M. B. Laskay ◽  
Brandon A. Sherrod ◽  
A. K. M. Fazlur Rahman ◽  
Harrison C. Walker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Pulse Generator ◽  
Rank Test ◽  
Implantable Pulse Generator ◽  
Device Infection ◽  
Deep Brain

OBJECTIVEInfection and erosion following implantable pulse generator (IPG) placement are associated with morbidity and cost for patients with deep brain stimulation (DBS) systems. Here, the authors provide a detailed characterization of infection and erosion events in a large cohort that underwent DBS surgery for movement disorders.METHODSThe authors retrospectively reviewed consecutive IPG placements and replacements in patients who had undergone DBS surgery for movement disorders at the University of Alabama at Birmingham between 2013 and 2016. IPG procedures occurring before 2013 in these patients were also captured. Descriptive statistics, survival analyses, and logistic regression were performed using generalized linear mixed effects models to examine risk factors for the primary outcomes of interest: infection within 1 year or erosion within 2 years of IPG placement.RESULTSIn the study period, 384 patients underwent a total of 995 IPG procedures (46.4% were initial placements) and had a median follow-up of 2.9 years. Reoperation for infection occurred after 27 procedures (2.7%) in 21 patients (5.5%). No difference in the infection rate was observed for initial placement versus replacement (p = 0.838). Reoperation for erosion occurred after 16 procedures (1.6%) in 15 patients (3.9%). Median time to reoperation for infection and erosion was 51 days (IQR 24–129 days) and 149 days (IQR 112–285 days), respectively. Four patients with infection (19.0%) developed a second infection requiring a same-side reoperation, two of whom developed a third infection. Intraoperative vancomycin powder was used in 158 cases (15.9%) and did not decrease the infection risk (infected: 3.2% with vancomycin vs 2.6% without, p = 0.922, log-rank test). On logistic regression, a previous infection increased the risk for infection (OR 35.0, 95% CI 7.9–156.2, p < 0.0001) and a lower patient BMI was a risk factor for erosion (BMI ≤ 24 kg/m2: OR 3.1, 95% CI 1.1–8.6, p = 0.03).CONCLUSIONSIPG-related infection and erosion following DBS surgery are uncommon but clinically significant events. Their respective timelines and risk factors suggest different etiologies and thus different potential corrective procedures.

scholarly journals A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Philip E. Mosley ◽  
François Windels ◽  
John Morris ◽  
Terry Coyne ◽  
Rodney Marsh ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Adverse Events ◽  
Brain Stimulation ◽  
Stria Terminalis ◽  
Treatment Resistant ◽  
Obsessive Compulsive ◽  
Double Blind ◽  
Bed Nucleus ◽  
Compulsive Disorder ◽  
Deep Brain

AbstractDeep brain stimulation (DBS) is a promising treatment for severe, treatment-resistant obsessive-compulsive disorder (OCD). Here, nine participants (four females, mean age 47.9 ± 10.7 years) were implanted with DBS electrodes bilaterally in the bed nucleus of the stria terminalis (BNST). Following a one-month postoperative recovery phase, participants entered a three-month randomised, double-blind, sham-controlled phase before a twelve-month period of open-label stimulation incorporating a course of cognitive behavioural therapy (CBT). The primary outcome measure was OCD symptoms as rated with the Yale-Brown Obsessive-Compulsive Scale (YBOCS). In the blinded phase, there was a significant benefit of active stimulation over sham (p = 0.025, mean difference 4.9 points). After the open phase, the mean reduction in YBOCS was 16.6 ± 1.9 points (χ2 (11) = 39.8, p = 3.8 × 10−5), with seven participants classified as responders. CBT resulted in an additive YBOCS reduction of 4.8 ± 3.9 points (p = 0.011). There were two serious adverse events related to the DBS device, the most severe of which was an infection during the open phase necessitating device explantation. There were no serious psychiatric adverse events related to stimulation. An analysis of the structural connectivity of each participant’s individualised stimulation field isolated right-hemispheric fibres associated with YBOCS reduction. These included subcortical tracts incorporating the amygdala, hippocampus and stria terminalis, in addition to cortical regions in the ventrolateral and ventromedial prefrontal cortex, parahippocampal, parietal and extrastriate visual cortex. In conclusion, this study provides further evidence supporting the efficacy and tolerability of DBS in the region of the BNST for individuals with otherwise treatment-refractory OCD and identifies a connectivity fingerprint associated with clinical benefit.

The risk factors of intracerebral hemorrhage in deep brain stimulation: does target matter?

2022 ◽  
Author(s):  
Hong Kyung Shin ◽  
Mi Sun Kim ◽  
Hyung Ho Yoon ◽  
Sun Ju Chung ◽  
Sang Ryong Jeon
Keyword(s):  
Risk Factors ◽  
Deep Brain Stimulation ◽  
Intracerebral Hemorrhage ◽  
Brain Stimulation ◽  
Deep Brain

Diplopia associated with loop routing in deep brain stimulation: illustrative case

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Yasushi Miyagi ◽  
Eiichirou Urasaki
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Electromagnetic Interference ◽  
Illustrative Case ◽  
Pulse Generators ◽  
Replacement Surgery ◽  
Dual Channel ◽  
Stimulation Parameters ◽  
External Sources ◽  
Deep Brain

BACKGROUNDDeep brain stimulation (DBS) is a powerful surgical option for drug-resistant movement disorders; however, electromagnetic interference (EMI) from external sources poses a potential risk for implanted electronics.OBSERVATIONSA 61-year-old woman with Parkinson’s disease originally had two implantable pulse generators (IPGs) for bilateral subthalamic DBS, which were then replaced with one dual-channel IPG routed in a loop. After the replacement surgery, with the same DBS programming as before the IPG replacement (bipolar setting for right, unipolar setting for left), the patient began to complain of transient paroxysmal diplopia. After multiple attempts to adjust the stimulation parameters, the diplopia was resolved by changing the left unipolar setting to a bipolar setting. At the authors’ institution, before the present case, four other patients had undergone IPG replacement with loop routing. None of these previous patients complained of diplopia; however, two of the four presented with diplopia in an experimental unipolar setting.LESSONSClinicians should be aware that loop-routed circuits may generate distortion of the stimulus field in DBS, even in the absence of external EMI sources.

scholarly journals Intracranial hemorrhage risk factors of deep brain stimulation for Parkinson’s disease: a 2-year follow-up study

2019 ◽  
Vol 48 (5) ◽  
pp. 030006051985674
Author(s):  
Chunhui Yang ◽  
Yiqing Qiu ◽  
Jiali Wang ◽  
Yina Wu ◽  
Xiaowu Hu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Parkinson’S Disease ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Intracranial Hemorrhage ◽  
Brain Stimulation ◽  
Puncture Site ◽  
Male Sex ◽  
Deep Brain

Objective This study aimed to analyze the risk factors of intracranial hemorrhage (ICH) after deep brain stimulation (DBS) for idiopathic Parkinson’s disease (PD). Methods Patients who received DBS from March 2014 to December 2016 were retrospectively analyzed. The hemorrhage index was derived by combining the hemorrhagic volume and clinical manifestations of ICH. All patients with IHC were followed up for 2 years. Results Computed tomography showed 13 events of ICH in 11 patients (nine cases in the subthalamic nucleus), including eight cases with symptomatic hemorrhage (seven cases in the subthalamic nucleus). Hemorrhage was characterized by intracranial hematoma in the electrode puncture tract. Male sex and hypertension were significant risk factors for ICH. Hemorrhage in the preferred puncture side was significantly higher than that in the non-preferred puncture side. The mean hemorrhage index was 2.23 ± 0.83 in 11 patients, and no permanent neurological impairment was found during the 2-year follow-up. The effect of DBS on motor symptoms was similar in patients with and without ICH. Conclusion Male sex and hypertension are risk factors of ICH after DBS in PD. The risk of hemorrhage on the first puncture site is significantly higher than that on the second puncture site.

Skin complications in deep brain stimulation for Parkinson’s disease: frequency, time course, and risk factors

2009 ◽  
Vol 152 (2) ◽  
pp. 195-200 ◽  
Author(s):  
Friederike Sixel-Döring ◽  
Claudia Trenkwalder ◽  
Christoph Kappus ◽  
Dieter Hellwig
Keyword(s):  
Risk Factors ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Time Course ◽  
Deep Brain

scholarly journals Characterization of the stimulus waveforms generated by implantable pulse generators for deep brain stimulation

2018 ◽  
Vol 129 (4) ◽  
pp. 731-742 ◽  
Author(s):  
Scott F. Lempka ◽  
Bryan Howell ◽  
Kabilar Gunalan ◽  
Andre G. Machado ◽  
Cameron C. McIntyre
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Pulse Generators ◽  
Deep Brain

scholarly journals Deep brain stimulation hardware–related infections: 10-year experience at a single institution

2019 ◽  
Vol 130 (2) ◽  
pp. 629-638 ◽  
Author(s):  
Kingsley O. Abode-Iyamah ◽  
Hsiu-Yin Chiang ◽  
Royce W. Woodroffe ◽  
Brian Park ◽  
Francis J. Jareczek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Single Institution ◽  
Chi Square ◽  
Related Factors ◽  
Exact Test ◽  
Vancomycin Powder ◽  
The Impact ◽  
Deep Brain

OBJECTIVEDeep brain stimulation is an effective surgical treatment for managing some neurological and psychiatric disorders. Infection related to the deep brain stimulator (DBS) hardware causes significant morbidity: hardware explantation may be required; initial disease symptoms such as tremor, rigidity, and bradykinesia may recur; and the medication requirements for adequate disease management may increase. These morbidities are of particular concern given that published DBS-related infection rates have been as high as 23%. To date, however, the key risk factors for and the potential preventive measures against these infections remain largely uncharacterized. In this study, the authors endeavored to identify possible risk factors for DBS-related infection and analyze the efficacy of prophylactic intrawound vancomycin powder (VP).METHODSThe authors performed a retrospective cohort study of patients who had undergone primary DBS implantation at a single institution in the period from December 2005 through September 2015 to identify possible risk factors for surgical site infection (SSI) and to assess the impact of perioperative (before, during, and after surgery) prophylactic antibiotics on the SSI rate. They also evaluated the effect of a change in the National Healthcare Safety Network’s definition of SSI on the number of infections detected. Statistical analyses were performed using the 2-sample t-test, the Wilcoxon rank-sum test, the chi-square test, Fisher’s exact test, or logistic regression, as appropriate for the variables examined.RESULTSFour hundred sixty-four electrodes were placed in 242 adults during 245 primary procedures over approximately 10.5 years; most patients underwent bilateral electrode implantation. Among the 245 procedures, 9 SSIs (3.7%) occurred within 90 days and 16 (6.5%) occurred within 1 year of DBS placement. Gram-positive bacteria were the most common etiological agents. Most patient- and procedure-related characteristics did not differ between those who had acquired an SSI and those who had not. The rate of SSIs among patients who had received intrawound VP was only 3.3% compared with 9.7% among those who had not received topical VP (OR 0.32, 95% CI 0.10–1.02, p = 0.04). After controlling for patient sex, the association between VP and decreased SSI risk did not reach the predetermined level of significance (adjusted OR 0.32, 95% CI 0.10–1.03, p = 0.06). The SSI rates were similar after staged and unstaged implantations.CONCLUSIONSWhile most patient-related and procedure-related factors assessed in this study were not associated with the risk for an SSI, the data did suggest that intrawound VP may help to reduce the SSI risk after DBS implantation. Furthermore, given the implications of SSI after DBS surgery and the frequency of infections occurring more than 90 days after implantation, continued follow-up for at least 1 year after such a procedure is prudent to establish the true burden of these infections and to properly treat them when they do occur.

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