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Lee S, Kim HJ, Jin B, Kim S, Jeon H, Woo KA, Shin JH, Myeong HS, Paek SH, Jeon B. Emergency Department Visits in Patients with Parkinson's Disease with Deep Brain Stimulation. Mov Disord Clin Pract 2024; 11:914-916. [PMID: 38594819 PMCID: PMC11233832 DOI: 10.1002/mdc3.14047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024] Open
Affiliation(s)
- Seungmin Lee
- Department of Neurology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - Bora Jin
- Department of Neurology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - Seoyeon Kim
- Department of Neurology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - HoYoung Jeon
- Department of Neurology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - Kyung Ah Woo
- Department of Neurology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jung Hwan Shin
- Department of Neurology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - Ho-Sung Myeong
- Department of Neurosurgery, Seoul National University Hospital, Cancer Research Institute, Hypoxic/Ischemic Disease Institute, College of Medicine, Seoul National University, Seoul, South Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Cancer Research Institute, Hypoxic/Ischemic Disease Institute, College of Medicine, Seoul National University, Seoul, South Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
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Sierra-Fernández CR, Garnica-Geronimo LR, Huipe-Dimas A, Ortega-Hernandez JA, Ruiz-Mafud MA, Cervantes-Arriaga A, Hernández-Medrano AJ, Rodríguez-Violante M. Electrocardiographic approach strategies in patients with Parkinson disease treated with deep brain stimulation. Front Cardiovasc Med 2024; 11:1265089. [PMID: 38682099 PMCID: PMC11047133 DOI: 10.3389/fcvm.2024.1265089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024] Open
Abstract
Deep brain stimulation (DBS) is an interdisciplinary and reversible therapy that uses high-frequency electrical stimulation to correct aberrant neural pathways in motor and cognitive neurological disorders. However, the high frequency of the waves used in DBS can interfere with electrical recording devices (e.g., electrocardiogram, electroencephalogram, cardiac monitor), creating artifacts that hinder their interpretation. The compatibility of DBS with these devices varies and depends on factors such as the underlying disease and the configuration of the neurostimulator. In emergencies where obtaining an electrocardiogram is crucial, the need for more consensus on reducing electrical artifacts in patients with DBS becomes a significant challenge. Various strategies have been proposed to attenuate the artifact generated by DBS, such as changing the DBS configuration from monopolar to bipolar, temporarily deactivating DBS during electrocardiographic recording, applying frequency filters both lower and higher than those used by DBS, and using non-standard leads. However, the inexperience of medical personnel, variability in DBS models, or the lack of a controller at the time of approach limit the application of these strategies. Current evidence on their reproducibility and efficacy is limited. Due to the growing elderly population and the rising utilization of DBS, it is imperative to create electrocardiographic methods that are easily accessible and reproducible for general physicians and emergency services.
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Affiliation(s)
| | | | - Alejandra Huipe-Dimas
- Department of Medical Education, National Institute of Cardiology Ignacio Chávez, Mexico, Mexico
| | | | - María Alejandra Ruiz-Mafud
- Department of Movement Disorders, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico, Mexico
| | - Amin Cervantes-Arriaga
- Department of Movement Disorders, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico, Mexico
| | - Ana Jimena Hernández-Medrano
- Department of Movement Disorders, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico, Mexico
| | - Mayela Rodríguez-Violante
- Department of Movement Disorders, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico, Mexico
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Douglas-Vail MB, Parmar HR, Migneault D. An unusual case of myoclonic convulsions after surgical intervention for essential tremor. CAN J EMERG MED 2023; 25:778-779. [PMID: 37491667 DOI: 10.1007/s43678-023-00560-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023]
Affiliation(s)
- Matthew B Douglas-Vail
- Department of Emergency Medicine, Faculty of Medicine, Diamond Health Care Centre, University of British Columbia, Vancouver, BC, Canada.
| | - Hanna R Parmar
- Department of Emergency Medicine, Faculty of Medicine, Diamond Health Care Centre, University of British Columbia, Vancouver, BC, Canada
| | - David Migneault
- Department of Emergency Medicine, Faculty of Medicine, Diamond Health Care Centre, University of British Columbia, Vancouver, BC, Canada
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Higuchi MA, Martinez-Ramirez D, Morita H, Topiol D, Bowers D, Ward H, Warren L, DeFranco M, Hicks JA, Hegland KW, Troche MS, Kulkarni S, Hastings E, Foote KD, Okun MS. Interdisciplinary Parkinson's Disease Deep Brain Stimulation Screening and the Relationship to Unintended Hospitalizations and Quality of Life. PLoS One 2016; 11:e0153785. [PMID: 27159519 PMCID: PMC4861342 DOI: 10.1371/journal.pone.0153785] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 04/04/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the impact of pre-operative deep brain stimulation (DBS) interdisciplinary assessments on post-operative hospitalizations and quality of life (QoL). Background DBS has been utilized successfully in Parkinson’s disease (PD) for the treatment of tremor, rigidity, bradykinesia, off time, and motor fluctuations. Although DBS is becoming a more common management approach there are no standardized criteria for selection of DBS candidates, and sparse data exist to guide the use of interdisciplinary evaluations for DBS screening. We reviewed the outcomes of the use of an interdisciplinary model which utilized seven specialties to pre-operatively evaluate potential DBS candidates. Methods The University of Florida (UF) INFORM database was queried for PD patients who had DBS implantations performed at UF between January 2011 and February 2013. Records were reviewed to identify unintended hospitalizations, falls, and infections. Minor and major concerns or reservations from each specialty were previously documented and quantified. Clinical outcomes were assessed through the use of the Parkinson disease quality of life questionnaire (PDQ-39), and the Unified Parkinson’s Disease Rating Score (UPDRS) Part III. Results A total of 164 cases were evaluated for possible DBS candidacy. There were 133 subjects who were approved for DBS surgery (81%) following interdisciplinary screening. There were 28 cases (21%) who experienced an unintended hospitalization within the first 12 months following the DBS operation. The patients identified during interdisciplinary evaluation with major or minor concerns from any specialty service had more unintended hospitalizations (93%) when compared to those without concerns (7%). When the preoperative “concern” shifted from “major” to “minor” to “no concerns,” the rate of hospitalization decreased from 89% to 33% to 3%. A strong relationship was uncovered between worsened PDQ-39 at 12 months and increased hospitalization. Conclusions Unintended hospitalizations and worsened QOL scores correlated with the number and severity of concerns raised by interdisciplinary DBS evaluations. The data suggest that detailed screenings by interdisciplinary teams may be useful for more than just patient selection. These evaluations may help to stratify risk for post-operative hospitalization and QoL outcomes.
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Affiliation(s)
- Masa-aki Higuchi
- Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Daniel Martinez-Ramirez
- Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Hokuto Morita
- Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Dan Topiol
- Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, United States of America
| | - Herbert Ward
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Lisa Warren
- Rehabilitation Services, University Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Meredith DeFranco
- Rehabilitation Services, University Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Julie A. Hicks
- Department of Speech, Language, and Hearing Sciences, University of Florida College of Public Health and Health Professions, Gainesville, Florida, United States of America
| | - Karen W. Hegland
- Department of Speech, Language, and Hearing Sciences, University of Florida College of Public Health and Health Professions, Gainesville, Florida, United States of America
| | - Michelle S. Troche
- Department of Speech, Language, and Hearing Sciences, University of Florida College of Public Health and Health Professions, Gainesville, Florida, United States of America
| | - Shankar Kulkarni
- Rehabilitation Services, University Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Erin Hastings
- Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Kelly D. Foote
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Michael S. Okun
- Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, United States of America
- * E-mail:
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Impact of an Interdisciplinary Deep Brain Stimulation Screening Model on Post-Surgical Complications in Essential Tremor Patients. PLoS One 2015; 10:e0145623. [PMID: 26710099 PMCID: PMC4692495 DOI: 10.1371/journal.pone.0145623] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate the relationship of our interdisciplinary screening process on post-operative unintended hospitalizations and quality of life. Background There are currently no standardized criteria for selection of appropriate Deep Brain Stimulation candidates and little hard data exists to support the use of any singular method. Methods An Essential Tremor cohort was selected from our institutional Deep Brain Stimulation database. The interdisciplinary model utilized seven specialties who pre-operatively screened all potential Deep Brain Stimulation candidates. Concerns for surgery raised by each specialty were documented and classified as none, minor, or major. Charts were reviewed to identify unintended hospitalizations and quality of life measurements at 1 year post-surgery. Results Eighty-six percent (44/51) of the potential screened candidates were approved for Deep Brain Stimulation. Eight (18%) patients had an unintended hospitalization during the follow-up period. Patients with minor or major concerns raised by any specialty service had significantly more unintended hospitalizations when compared to patients without concerns (75% vs. 25%, p < 0.005). The rate of hospitalization revealed a direct relationship to the “level of concern”; ranging from 100% if major concerns, 42% if minor concerns, and 7% if no concerns raised, p = 0.001. Quality of life scores significantly worsened in patients with unintended hospitalizations at 6 (p = 0.046) and 12 months (p = 0.027) when compared to baseline scores. No significant differences in tremor scores between unintended and non-unintended hospitalizations were observed. Conclusions The number and level of concerns raised during interdisciplinary Deep Brain Stimulation screenings were significantly related to unintended hospitalizations and to a reduced quality of life. The interdisciplinary evaluation may help to stratify risk for these complications. However, data should be interpreted with caution due to the limitations of our study. Further prospective comparative and larger studies are required to confirm our results.
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Quinn DK, Deligtisch A, Rees C, Brodsky A, Evans D, Khafaja M, Abbott CC. Differential diagnosis of psychiatric symptoms after deep brain stimulation for movement disorders. Neuromodulation 2014; 17:629-36; discussion 636. [PMID: 24512146 DOI: 10.1111/ner.12153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 11/28/2013] [Accepted: 12/12/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The presence of a deep brain stimulator (DBS) in a patient with a movement disorder who develops psychiatric symptoms poses unique diagnostic and therapeutic challenges for the treating clinician. Few sources discuss approaches to diagnosing and treating these symptoms. MATERIALS AND METHODS The authors review the literature on psychiatric complications in DBS for movement disorders and propose a heuristic for categorizing symptoms according to their temporal relationship with the DBS implantation process. RESULTS Psychiatric symptoms after DBS can be categorized as preimplantation, intra-operative/perioperative, stimulation related, device malfunction, medication related, and chronic stimulation related/long term. Once determined, the specific etiology of a symptom guides the practitioner in treatment. CONCLUSIONS A structured approach to psychiatric symptoms in DBS patients allows practitioners to effectively diagnose and treat them when they arise.
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Affiliation(s)
- Davin K Quinn
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Syncope associated with subthalamic nucleus deep brain stimulation in a patient with Parkinson's disease. Case Rep Neurol Med 2014; 2013:371929. [PMID: 24455344 PMCID: PMC3881384 DOI: 10.1155/2013/371929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 12/04/2013] [Indexed: 11/18/2022] Open
Abstract
In advanced Parkinson's disease (PD), deep brain stimulation (DBS) may be an alternative option for the treatment of motor symptoms. Side effects associated with subthalamic nucleus (STN) DBS in patients with PD are emerging as the most frequent sensory and motor symptoms. DBS-related syncope is reported as extremely rare. We wanted to discuss the mechanisms of syncope associated with STN DBS in a patient with Parkinson's disease. Case report. Sixty-three-year-old female patient is followed up with diagnosis of idiopathic Parkinson's disease for 6 years in our clinic. The patient has undergone STN DBS due to painful dystonia and drug resistant tremor. During the operation, when the left STN was stimulated at 5 milliampere (mAmp), the patient developed presyncopal symptoms. However, when the stimulation was stopped symptoms improved. During the early period after the operation, when the right STN was stimulated at 1.3 millivolts (mV), she developed the pre-yncopal symptoms and then syncope. Our case shows that STN DBS may lead to directly autonomic symptoms resulting in syncope during stimulation-on (stim-on).
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Bell E, Racine E. Ethics guidance for neurological and psychiatric deep brain stimulation. HANDBOOK OF CLINICAL NEUROLOGY 2013; 116:313-25. [DOI: 10.1016/b978-0-444-53497-2.00026-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Bell E, Maxwell B, McAndrews MP, Sadikot A, Racine E. Deep brain stimulation and ethics: perspectives from a multisite qualitative study of Canadian neurosurgical centers. World Neurosurg 2012; 76:537-47. [PMID: 22251502 DOI: 10.1016/j.wneu.2011.05.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 03/18/2011] [Accepted: 05/13/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an approved neurosurgical intervention for motor disorders such as Parkinson disease. The emergence of psychiatric uses for DBS combined with the fact that it is an invasive and expensive procedure creates important ethical and social challenges in the delivery of care that need further examination. We endeavored to examine health care provider perspectives on ethical and social challenges encountered in DBS. METHODS Health care providers working in Canadian DBS surgery programs participated in a semistructured interview to identify and characterize ethical and social challenges of DBS. A content analysis of the interviews was conducted. RESULTS Several key ethical issues, such as patient screening and resource allocation, were identified by members of neurosurgical teams. Providers described challenges in selecting patients for DBS on the basis of unclear evidence-based guidance regarding behavioral issues or cognitive criteria. Varied contexts of resource allocation, including some very challenging schemas, were also reported. In addition, the management of patients in the community was highlighted as a source of ethical and clinical complexity, given the need for coordinated long-term care. CONCLUSIONS This study provides insights into the complexity of ethical challenges that providers face in the use of DBS across different neurosurgical centers. We propose actions for health care providers for the long-term care and postoperative monitoring of patients with DBS. More data on patient perspectives in DBS would complement the understanding of key challenges, as well as contribute to best practices, for patient selection, management, and resource allocation.
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Affiliation(s)
- Emily Bell
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
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Thompson A, Morishita T, Okun MS. DBS and electrical neuro-network modulation to treat neurological disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2012. [PMID: 23206686 DOI: 10.1016/b978-0-12-404706-8.00014-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The use of neuromodulatory techniques in the treatment of neurological disorders is expanding and now includes devices targeting the motor cortex, basal ganglia, spinal cord, peripheral nervous system, and autonomic nervous system. In this chapter, we review and discuss the current and past literature as well as review indications for each of these devices in the ongoing management of many common neurological diseases including chronic pain, Parkinson's disease, tremor, dystonia, and epilepsy. We also discuss and update mechanisms of deep brain stimulation and electrical neuro-network modulation.
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Affiliation(s)
- Amanda Thompson
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, USA
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Baizabal Carvallo JF, Simpson R, Jankovic J. Diagnosis and treatment of complications related to deep brain stimulation hardware. Mov Disord 2011; 26:1398-406. [PMID: 21714001 DOI: 10.1002/mds.23800] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 04/09/2011] [Accepted: 04/18/2011] [Indexed: 11/08/2022] Open
Abstract
Deep brain stimulation is a therapeutic technique increasingly used in the treatment of a variety of neurological, psychiatric, and pain disorders. Although beneficial, it carries the immediate and long-term risks associated with implanted hardware in the brain parenchyma and subcutaneous tissue. The most common hardware complications include electrode migrations or misplacements, wire fractures, skin erosion, infections, and device malfunction. We systematically reviewed the literature on deep brain stimulation-related complications and propose a diagnostic and therapeutic algorithm. Our aim is to provide a guide for clinicians and medical staff involved in the treatment of patients with deep brain stimulation for rapid recognition and efficient management of these complications.
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Affiliation(s)
- José Fidel Baizabal Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
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Affiliation(s)
- Sion L Jones
- School of Medical Sciences University of Bangor Llandudno Hospital
| | - John V Hindle
- School of Medical Sciences University of Bangor Llandudno Hospital
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Morishita T, Foote KD, Burdick AP, Katayama Y, Yamamoto T, Frucht SJ, Okun MS. Identification and management of deep brain stimulation intra- and postoperative urgencies and emergencies. Parkinsonism Relat Disord 2010; 16:153-62. [PMID: 19896407 PMCID: PMC2829374 DOI: 10.1016/j.parkreldis.2009.10.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 09/23/2009] [Accepted: 10/01/2009] [Indexed: 10/20/2022]
Abstract
Deep brain stimulation (DBS) has been increasingly utilized for the therapeutic treatment of movement disorders, and with the advent of this therapy more postoperative urgencies and emergencies have emerged. In this paper, we will review, identify, and suggest management strategies for both intra- and postoperative urgencies and emergencies. We have separated the scenarios into 1--surgery/procedure related, 2--hardware related, 3--stimulation-induced difficulties, and 4--others. We have included ten illustrative (and actual) case vignettes to augment the discussion of each issue.
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Affiliation(s)
- Takashi Morishita
- Department of Neurology, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Kelly D. Foote
- Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL
| | - Adam P. Burdick
- Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL
| | - Yoichi Katayama
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
- Division of Applied System Neuroscience, Department of Advanced Medical Science, Nihon University School of Medicine, Tokyo, Japan
| | - Takamitsu Yamamoto
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
- Division of Applied System Neuroscience, Department of Advanced Medical Science, Nihon University School of Medicine, Tokyo, Japan
| | - Steven J. Frucht
- Department of Neurology, Columbia University College of Physicians and Surgeons/Columbia-Presbyterian Medical Center, New York, NY
| | - Michael S. Okun
- Department of Neurology, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL
- Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL
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