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Oberholzer J, Fayolle D, Vandenbulcke A, Gaudet JG. Cardiac arrest during deep brain stimulation: A case report. Clin Case Rep 2024; 12:e9147. [PMID: 39005577 PMCID: PMC11239760 DOI: 10.1002/ccr3.9147] [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: 04/17/2024] [Revised: 06/05/2024] [Accepted: 06/18/2024] [Indexed: 07/16/2024] Open
Abstract
We present the case of a 54-year-old male with severe Parkinson's disease and chronic, non-reversible pulmonary artery hypertension who had seizures and a cardiorespiratory arrest during surgery for deep brain stimulation, a minimally invasive procedure usually associated with a low risk of complications. This case illustrates how perioperative changes in antiparkinsonian therapy in patient with multiple comorbidities may significantly affect the risk profile.
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Affiliation(s)
- Julian Oberholzer
- Department of AnesthesiologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - Damien Fayolle
- Department of NeurologyHôpitaux Universitaires GenèveGenevaSwitzerland
| | - Alberto Vandenbulcke
- Department of NeurosurgeryCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - John G. Gaudet
- Department of AnesthesiologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
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Wu B, Liu J, Jiang L, Xu J, Xuan R, Ling Y, Guo Q, Jiang N, Chen L, Zhang C. Delayed-onset seizures after subthalamic nucleus deep brain stimulation surgery for Parkinson's disease. J Clin Neurosci 2024; 124:81-86. [PMID: 38669906 DOI: 10.1016/j.jocn.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Delayed-onset seizures after deep brain stimulation (DBS) surgery were seldom reported. This study summarized the clinical characteristics of delayed-onset seizures after subthalamic nucleus (STN) DBS surgery for Parkinson's disease (PD) and analyzed risk factors. METHODS A single-center retrospective study containing consecutive STN-DBS PD patients from 2006 to 2021 was performed. Seizures occurred during the DBS surgery or within one month after DBS surgery were identified based on routine clinical records. Patients with postoperative magnetic resonance imaging (MRI) were included to further analyze the risk factors for postoperative seizures with univariate and multivariate statistical methods. RESULTS 341 consecutive PD patients treated with bilateral STN-DBS surgery wereidentified, and five patients experienced seizures after DBS surgery with an incidence of 1.47 %. All seizures of the five cases were characterized as delayed onset with average 12 days post-operatively. All seizures presented as generalized tonic-clonic seizures and didn't recur after the first onset. In those seizures cases, peri-electrode edema was found in both hemispheres without hemorrhage and infarction. The average diameter of peri-electrode edema of patients with seizures was larger than those without seizures (3.15 ± 1.00 cm vs 1.57 ± 1.02 cm, p = 0.005). Multivariate risk factor analysis indicated that seizures were only associated with the diameter of peri-electrode edema (OR 4.144, 95 % CI 1.269-13.530, p = 0.019). CONCLUSIONS Delayed-onset seizures after STN-DBS surgery in PD patients were uncommon with an incidence of 1.47 % in this study. The seizures were transient and self-limiting, with no developing into chronic epilepsy. Peri-electrode edema was a risk factor for delayed-onset seizures after DBS surgery. Patients with an average peri-electrode edema diameter > 2.70 cm had a higher risk to develop seizures.
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Affiliation(s)
- Bin Wu
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China; Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China; Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai 200433, China
| | - Jinlong Liu
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Lulu Jiang
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Jiakun Xu
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Ruoheng Xuan
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yuting Ling
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Qianqian Guo
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Nan Jiang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Ling Chen
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Changming Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
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Li HT, Viskaitis P, Bracey E, Peleg-Raibstein D, Burdakov D. Transient targeting of hypothalamic orexin neurons alleviates seizures in a mouse model of epilepsy. Nat Commun 2024; 15:1249. [PMID: 38341419 PMCID: PMC10858876 DOI: 10.1038/s41467-024-45515-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Lateral hypothalamic (LH) hypocretin/orexin neurons (HONs) control brain-wide electrical excitation. Abnormally high excitation produces epileptic seizures, which affect millions of people and need better treatments. HON population activity spikes from minute to minute, but the role of this in seizures is unknown. Here, we describe correlative and causal links between HON activity spikes and seizures. Applying temporally-targeted HON recordings and optogenetic silencing to a male mouse model of acute epilepsy, we found that pre-seizure HON activity predicts and controls the electrophysiology and behavioral pathology of subsequent seizures. No such links were detected for HON activity during seizures. Having thus defined the time window where HONs influence seizures, we targeted it with LH deep brain stimulation (DBS), which inhibited HON population activity, and produced seizure protection. Collectively, these results uncover a feature of brain activity linked to seizures, and demonstrate a proof-of-concept treatment that controls this feature and alleviates epilepsy.
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Affiliation(s)
- Han-Tao Li
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology | ETH Zurich, 8603, Schwerzenbach, Switzerland
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, 333, Taoyuan, Taiwan
| | - Paulius Viskaitis
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology | ETH Zurich, 8603, Schwerzenbach, Switzerland
| | - Eva Bracey
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology | ETH Zurich, 8603, Schwerzenbach, Switzerland
| | - Daria Peleg-Raibstein
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology | ETH Zurich, 8603, Schwerzenbach, Switzerland
| | - Denis Burdakov
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology | ETH Zurich, 8603, Schwerzenbach, Switzerland.
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Servello D, Galbiati TF, Iess G, Minafra B, Porta M, Pacchetti C. Complications of deep brain stimulation in Parkinson's disease: a single-center experience of 517 consecutive cases. Acta Neurochir (Wien) 2023; 165:3385-3396. [PMID: 37773459 DOI: 10.1007/s00701-023-05799-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/03/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The number of deep brain stimulation (DBS) procedures is rapidly rising as well as the novel indications. Reporting adverse events related to surgery and to the hardware used is essential to define the risk-to-benefit ratio and develop novel strategies to improve it. OBJECTIVE To analyze DBS complications (both procedure-related and hardware-related) and further assess potential predictive factors. METHODS Five hundred seventeen cases of DBS for Parkinson's disease were performed between 2006 and 2021 in a single center (mean follow-up: 4.68 ± 2.86 years). Spearman's Rho coefficient was calculated to search for a correlation between the occurrence of intracerebral hemorrhage (ICH) and the number of recording tracks. Multiple logistic regression analyzed the probability of developing seizures and ICH given potential risk factors. Kaplan-Meier curves were performed to analyze the cumulative proportions of hardware-related complications. RESULTS Mortality rate was 0.2%, while permanent morbidity 0.6%. 2.5% of cases suffered from ICH which were not influenced by the number of tracks used for recordings. 3.3% reported seizures that were significantly affected by perielectrode brain edema and age. The rate of perielectrode brain edema was significantly higher for Medtronic's leads compared to Boston Scientific's (Χ2(1)= 5.927, P= 0.015). 12.2% of implants reported Hardware-related complications, the most common of which were wound revisions (7.2%). Internal pulse generator models with smaller profiles displayed more favorable hardware-related complication survival curves compared to larger designs (X2(1)= 8.139, P= 0.004). CONCLUSION Overall DBS has to be considered a safe procedure, but future research is needed to decrease the rate of hardware-related complications which may be related to both the surgical technique and to the specific hardware's design. The increased incidence of perielectrode brain edema associated with certain lead models may likewise deserve future investigation.
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Affiliation(s)
- Domenico Servello
- Neurosurgical Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy
| | | | - Guglielmo Iess
- Neurosurgical Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy
| | - Brigida Minafra
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Mauro Porta
- Neurosurgical Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy
| | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
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Abstract
SignificanceAnxiety disorders are among the most prevalent mental illnesses worldwide. Despite significant advances in their treatment, many patients remain treatment resistant. Thus, new treatment modalities and targets are much needed. Therefore, we developed a deep brain stimulation therapy that targets a recently identified anxiety center in the lateral hypothalamus. We show that this therapy rapidly silences anxiety-implicated neurons and immediately relieves diverse anxiety symptoms in a variety of stressful situations. This therapeutic effect occurs without acute or chronic side effects that are typical of many existing treatments, such as physical sedation or memory deficits. These findings identify a clinically applicable new therapeutic strategy for helping patients to manage treatment-resistant anxiety.
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Charmley AR, Kimber T, Mahant N, Lehn A. Driving restrictions following deep brain stimulation surgery. BMJ Neurol Open 2021; 3:e000210. [PMID: 34964044 PMCID: PMC8653775 DOI: 10.1136/bmjno-2021-000210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/28/2021] [Indexed: 11/04/2022] Open
Abstract
Background There are currently no Australian guidelines to assist clinicians performing deep brain stimulation (DBS) procedures in setting postoperative driving restrictions. Purpose We aimed to provide recommendations for post-DBS driving restrictions to guide practice in Australia. Methods A review of current Australian and international driving guidelines, literature regarding the adverse effects of DBS and literature regarding the long-term effect of neurostimulation on driving was conducted using Elton B Stephens Company discovery service-linked databases. Australian neurologists and neurosurgeons who perform DBS were surveyed to gain insight into existing practice. Results No guidance on driving restrictions following DBS surgery was found, either in existing driving guidelines or in the literature. There was a wide difference seen in the rates of reported adverse effects from DBS surgery. The most serious adverse events (haemorrhage, seizure and neurological dysfunction) were uncommon. Longer term, there does not appear to be any adverse effect of DBS on driving ability. Survey of Australian practitioners revealed a universal acceptance of the need for and use of driving restrictions after DBS but significant heterogeneity in how return to driving is managed. Conclusion We propose a 6-week driving restriction for private licences and 6-month driving restriction for commercial licences in uncomplicated DBS. We also highlight some of the potential pitfalls and pearls to assist clinicians to modify these recommendations where needed. Ultimately, we hope this will stimulate further examination of this issue in research and by regulatory bodies to provide more robust direction for practitioners performing DBS implantation.
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Affiliation(s)
- Andrew Roy Charmley
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Thomas Kimber
- Central Adelaide Neurology Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Neil Mahant
- Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
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Atchley TJ, Elsayed GA, Sowers B, Walker HC, Chagoya G, Davis MC, Bernstock JD, Omar NB, Patel DM, Guthrie BL. Incidence and risk factors for seizures associated with deep brain stimulation surgery. J Neurosurg 2021; 135:279-283. [PMID: 32764176 DOI: 10.3171/2020.5.jns20125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/11/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to determine the incidence of seizures following deep brain stimulation (DBS) electrode implantation and to evaluate factors associated with postoperative seizures. METHODS The authors performed a single-center retrospective case-control study. The outcome of interest was seizure associated with DBS implantation. Univariate analyses were performed using the Student t-test for parametric continuous outcomes. The authors used the Kruskal-Wallis test or Wilcoxon rank-sum test for nonparametric continuous outcomes, chi-square statistics for categorical outcomes, and multivariate logistic regression for binomial variables. RESULTS A total of 814 DBS electrode implantations were performed in 645 patients (478 [58.7%] in men and 520 [63.9%] in patients with Parkinson's disease). In total, 22 (3.4%) patients who had undergone 23 (2.8%) placements experienced seizure. Of the 23 DBS implantation-related seizures, 21 were new-onset seizures (3.3% of 645 patients) and 2 were recurrence or worsening of a prior seizure disorder. Among the 23 cases with postimplantation-related seizure, epilepsy developed in 4 (17.4%) postoperatively; the risk of DBS-associated epilepsy was 0.50% per DBS electrode placement and 0.63% per patient. Nine (39.1%) implantation-related seizures had associated postoperative radiographic abnormalities. Multivariate analyses suggested that age at surgery conferred a modest increased risk for postoperative seizures (OR 1.06, 95% CI 1.02-1.10). Sex, primary diagnosis, electrode location and sidedness, and the number of trajectories were not significantly associated with seizures after DBS surgery. CONCLUSIONS Seizures associated with DBS electrode placement are uncommon, typically occur early within the postoperative period, and seldom lead to epilepsy. This study suggests that patient characteristics, such as age, may play a greater role than perioperative variables in determining seizure risk. Multiinstitutional studies may help better define and mitigate the risk of seizures after DBS surgery.
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Affiliation(s)
| | | | - Blake Sowers
- 2University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; and
| | | | | | | | - Joshua D Bernstock
- 4Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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8
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Stereotactic electroencephalography. Clin Neurol Neurosurg 2020; 189:105640. [DOI: 10.1016/j.clineuro.2019.105640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 11/23/2022]
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Boutet A, Jain M, Elias GJB, Gramer R, Germann J, Davidson B, Coblentz A, Giacobbe P, Kucharczyk W, Wennberg RA, Ibrahim GM, Lozano AM. Network Basis of Seizures Induced by Deep Brain Stimulation: Literature Review and Connectivity Analysis. World Neurosurg 2019; 132:314-320. [PMID: 31449994 DOI: 10.1016/j.wneu.2019.08.094] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Whereas transient, self-limiting seizures are an infrequent but known complication of deep brain stimulation (DBS) implantation surgery, stimulation itself has occasionally been reported to result in seizure activity at delayed time points. The neural circuitry implicated in stimulation-induced seizures is unknown. CASE DESCRIPTION A 47-year-old woman underwent chronic subcallosal cingulate DBS for treatment of refractory anorexia nervosa and experienced seizure with stimulation onset. Supratherapeutic voltage caused a generalized seizure. The patient subsequently experienced a full recovery. We reviewed the literature for other cases of delayed postoperative DBS seizures associated with stimulation. We also investigated whether the higher voltage may have recruited networks implicated in epilepsy. The supratherapeutic voltage stimulated a larger area and engaged vulnerable networks, including bilateral hippocampi, cingulate gyrus, and temporal lobes. Literature review identified 20 studies reporting delayed seizure after DBS surgery, 13 of which demonstrated a robust association with mostly nonmotor DBS stimulation. CONCLUSIONS Nonmotor DBS targets, particularly in patients with epilepsy, may be more vulnerable to stimulation-induced seizures; as such, extra caution should be used when programming stimulation parameters at these DBS targets.
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Affiliation(s)
- Alexandre Boutet
- University Health Network, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Mehr Jain
- University Health Network, Toronto, Ontario, Canada
| | | | | | | | | | - Ailish Coblentz
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Giacobbe
- University of Toronto, Toronto, Ontario, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Walter Kucharczyk
- University Health Network, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Richard A Wennberg
- Krembil Brain Institute, Division of Neurology, University Health Network, Toronto, Ontario, Canada
| | - George M Ibrahim
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
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Siddiqui J, Aldaajani Z, Mehanna R, Changizi BK, Bhatti D, Al-Johani ZG, Shukla AW, Fernandez HH, Bajwa JA. Rationale and patient selection for interventional therapies in Parkinson’s disease. Expert Rev Neurother 2018; 18:811-823. [DOI: 10.1080/14737175.2018.1535902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Junaid Siddiqui
- Department of Neurology, Movement Disorders, University of Missouri, Columbia, MO, USA
| | - Zakiyah Aldaajani
- Department of Neurology, King Fahad Military Hospital, Dhahran, Saudi Arabia
| | - Raja Mehanna
- Department of Neurology, University of Texas Health Science Center, McGovern Medical School, Houston, TX, USA
| | - Barbara Kelly Changizi
- Department of Neurology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Danish Bhatti
- Department of Neurology, University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Hubert H. Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jawad A. Bajwa
- Parkinson’s, Movement Disorders and Neurorestoration Program, National Neuroscience Institute, Riyadh, Saudi Arabia
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Klinger N, Mittal S. Deep brain stimulation for seizure control in drug-resistant epilepsy. Neurosurg Focus 2018; 45:E4. [DOI: 10.3171/2018.4.focus1872] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Antiepileptic drugs prevent morbidity and death in a large number of patients suffering from epilepsy. However, it is estimated that approximately 30% of epileptic patients will not have adequate seizure control with medication alone. Resection of epileptogenic cortex may be indicated in medically refractory cases with a discrete seizure focus in noneloquent cortex. For patients in whom resection is not an option, deep brain stimulation (DBS) may be an effective means of seizure control. Deep brain stimulation targets for treating seizures primarily include the thalamic nuclei, hippocampus, subthalamic nucleus, and cerebellum. A variety of stimulation parameters have been studied, and more recent advances in electrical stimulation to treat epilepsy include responsive neurostimulation. Data suggest that DBS is effective for treating drug-resistant epilepsy.
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Affiliation(s)
- Neil Klinger
- 1Department of Neurosurgery, Wayne State University; and
- 2Comprehensive Epilepsy Program, Detroit Medical Center, Wayne State University, Detroit, Michigan
| | - Sandeep Mittal
- 1Department of Neurosurgery, Wayne State University; and
- 2Comprehensive Epilepsy Program, Detroit Medical Center, Wayne State University, Detroit, Michigan
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Experience Reduces Surgical and Hardware-Related Complications of Deep Brain Stimulation Surgery: A Single-Center Study of 181 Patients Operated in Six Years. PARKINSONS DISEASE 2018; 2018:3056018. [PMID: 30140425 PMCID: PMC6081564 DOI: 10.1155/2018/3056018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/23/2018] [Indexed: 12/18/2022]
Abstract
Objective Deep brain stimulation (DBS) surgery has increasingly been performed for the treatment of movement disorders and is associated with a wide array of complications. We aimed to present our experience and discuss strategies to minimize adverse events in light of this contemporary series and others in the literature. Methods A retrospective chart review was conducted to collect data on age, sex, indication, operation date, surgical technique, and perioperative and late complications. Results A total of 181 patients (113 males, 68 females) underwent DBS implantation surgery (359 leads) in the past six years. Indications and targets were as follows: Parkinson's disease (STN) (n=159), dystonia (GPi) (n=13), and essential tremor (Vim) (n=9). Mean age was 55.2 ± 11.7 (range 9-74) years. Mean follow-up duration was 3.4 ± 1.6 years. No mortality or permanent morbidity was observed. Major perioperative complications were confusion (6.6%), intracerebral hemorrhage (2.2%), stroke (1.1%), and seizures (1.1%). Long-term adverse events included wound (7.2%), mostly infection, and hardware-related (5.5%) complications. Among several factors, only surgical experience was found to be related with overall complication rates (early period: 31% versus late period: 10%; p=0.001). Conclusion The rates of both early and late complications of DBS surgery are acceptably low and decrease significantly with cumulative experience.
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Barnett SC, Perry BAL, Dalrymple-Alford JC, Parr-Brownlie LC. Optogenetic stimulation: Understanding memory and treating deficits. Hippocampus 2018; 28:457-470. [DOI: 10.1002/hipo.22960] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/24/2018] [Accepted: 05/02/2018] [Indexed: 01/01/2023]
Affiliation(s)
- S. C. Barnett
- Department of Psychology; University of Canterbury; Christchurch 8041 New Zealand
- Brain Research New Zealand; New Zealand
| | - B. A. L. Perry
- Department of Psychology; University of Canterbury; Christchurch 8041 New Zealand
- Brain Research New Zealand; New Zealand
| | - J. C. Dalrymple-Alford
- Department of Psychology; University of Canterbury; Christchurch 8041 New Zealand
- Brain Research New Zealand; New Zealand
- New Zealand Brain Research Institute; Christchurch New Zealand
| | - L. C. Parr-Brownlie
- Brain Research New Zealand; New Zealand
- Department of Anatomy, School of Biomedical Science; Brain Health Research Centre, University of Otago; Dunedin New Zealand
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Abstract
INTRODUCTION Essential tremor is the most common form of pathologic tremor. Surgical therapies disrupt tremorogenic oscillation in the cerebellothalamocortical pathway and are capable of abolishing severe tremor that is refractory to available pharmacotherapies. Surgical methods are raspidly improving and are the subject of this review. Areas covered: A PubMed search on 18 January 2018 using the query essential tremor AND surgery produced 839 abstracts. 379 papers were selected for review of the methods, efficacy, safety and expense of stereotactic deep brain stimulation (DBS), stereotactic radiosurgery (SRS), focused ultrasound (FUS) ablation, and radiofrequency ablation of the cerebellothalamocortical pathway. Expert commentary: DBS and SRS, FUS and radiofrequency ablations are capable of reducing upper extremity tremor by more than 80% and are far more effective than any available drug. The main research questions at this time are: 1) the relative safety, efficacy, and expense of DBS, SRS, and FUS performed unilaterally and bilaterally; 2) the relative safety and efficacy of thalamic versus subthalamic targeting; 3) the relative safety and efficacy of atlas-based versus direct imaging tractography-based anatomical targeting; and 4) the need for intraoperative microelectrode recordings and macroelectrode stimulation in awake patients to identify the optimum anatomical target. Randomized controlled trials are needed.
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Affiliation(s)
- Rodger J Elble
- a Neuroscience Institute , Southern Illinois University School of Medicine , Springfield , Illinois , USA
| | - Ludy Shih
- b Department of Neurology , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , Massachusetts USA
| | - Jeffrey W Cozzens
- a Neuroscience Institute , Southern Illinois University School of Medicine , Springfield , Illinois , USA
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15
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Effects of Transcranial Direct Current Stimulation Plus Physical Therapy on Gait in Patients With Parkinson Disease. Am J Phys Med Rehabil 2018. [DOI: 10.1097/phm.0000000000000783] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Spampanato J, Dudek FE. Targeted Interneuron Ablation in the Mouse Hippocampus Can Cause Spontaneous Recurrent Seizures. eNeuro 2017; 4:ENEURO.0130-17.2017. [PMID: 28785726 PMCID: PMC5520752 DOI: 10.1523/eneuro.0130-17.2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/30/2017] [Accepted: 07/11/2017] [Indexed: 12/21/2022] Open
Abstract
The death of GABAergic interneurons has long been hypothesized to contribute to acquired epilepsy. These experiments tested the hypothesis that focal interneuron lesions cause acute seizures [i.e., status epilepticus (SE)] and/or chronic epilepsy [i.e., persistent spontaneous recurrent seizures (SRSs)]. To selectively ablate interneurons, Gad2-ires-Cre mice were injected unilaterally in the CA1 area of the dorsal hippocampus with an adeno-associated virus containing the diphtheria toxin receptor (DTR). Simultaneously, an electrode, connected to a miniature telemetry device, was positioned at the injection site for chronic recordings of local field potentials (LFPs). Two weeks after virus transfection, intraperitoneal injection of DT consistently caused focal, specific, and extensive ablation of interneurons. Long-term, continuous monitoring revealed that all mice with DT-induced interneuron lesions had SRSs. Seizures lasted tens of seconds and interseizure intervals were several hours (or days); therefore, these interneuron lesions did not induce SE. The SRSs occurred 3-5 d after DT treatment, which is the estimated time required for DT-induced cell death; therefore, induction of SRSs occurred without the latent period typical of acquired epilepsy. In five of six DT-treated mice, SRSs stopped within days, suggesting that the DT-induced interneuron lesions did not usually cause epilepsy. In one mouse, however, SRSs occurred for ≥34 d after interneuron ablation, similar to epilepsy after experimental SE. Sham control mice had no detectable seizures, confirming that the SRSs were due to ablation of interneurons. These data show that selective interneuron ablation consistently caused SRSs but not SE; and, at least under the conditions used here, interneuron lesions rarely led to persistent SRSs (i.e., epilepsy).
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Affiliation(s)
- Jay Spampanato
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT 84108
| | - F Edward Dudek
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT 84108
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Lempka SF, Malone DA, Hu B, Baker KB, Wyant A, Ozinga JG, Plow EB, Pandya M, Kubu CS, Ford PJ, Machado AG. Randomized clinical trial of deep brain stimulation for poststroke pain. Ann Neurol 2017; 81:653-663. [DOI: 10.1002/ana.24927] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Scott F. Lempka
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center
| | | | - Bo Hu
- Department of Quantitative Health Sciences; Cleveland Clinic
| | - Kenneth B. Baker
- Department of Neurosciences; Lerner Research Institute, Cleveland Clinic
| | - Alexandria Wyant
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic
| | - John G. Ozinga
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic
| | - Ela B. Plow
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic
- Department of Biomedical Engineering; Lerner Research Institute, Cleveland Clinic
- Department of Physical Medicine and Rehabilitation; Neurological Institute, Cleveland Clinic
| | - Mayur Pandya
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic
| | - Cynthia S. Kubu
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic
- Department of Psychiatry and Psychology; Cleveland Clinic
| | - Paul J. Ford
- NeuroEthics Program, Cleveland Clinic; Cleveland OH
| | - Andre G. Machado
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic
- Department of Neurosciences; Lerner Research Institute, Cleveland Clinic
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18
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Jochim A, Gempt J, Deschauer M, Bernkopf K, Schwarz J, Kirschke JS, Haslinger B. Status Epilepticus After Subthalamic Deep Brain Stimulation Surgery in a Patient with Parkinson's Disease. World Neurosurg 2016; 96:614.e1-614.e6. [DOI: 10.1016/j.wneu.2016.08.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/13/2016] [Accepted: 08/17/2016] [Indexed: 11/25/2022]
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Klooster DCW, de Louw AJA, Aldenkamp AP, Besseling RMH, Mestrom RMC, Carrette S, Zinger S, Bergmans JWM, Mess WH, Vonck K, Carrette E, Breuer LEM, Bernas A, Tijhuis AG, Boon P. Technical aspects of neurostimulation: Focus on equipment, electric field modeling, and stimulation protocols. Neurosci Biobehav Rev 2016; 65:113-41. [PMID: 27021215 DOI: 10.1016/j.neubiorev.2016.02.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 02/05/2016] [Accepted: 02/17/2016] [Indexed: 12/31/2022]
Abstract
Neuromodulation is a field of science, medicine, and bioengineering that encompasses implantable and non-implantable technologies for the purpose of improving quality of life and functioning of humans. Brain neuromodulation involves different neurostimulation techniques: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), which are being used both to study their effects on cognitive brain functions and to treat neuropsychiatric disorders. The mechanisms of action of neurostimulation remain incompletely understood. Insight into the technical basis of neurostimulation might be a first step towards a more profound understanding of these mechanisms, which might lead to improved clinical outcome and therapeutic potential. This review provides an overview of the technical basis of neurostimulation focusing on the equipment, the present understanding of induced electric fields, and the stimulation protocols. The review is written from a technical perspective aimed at supporting the use of neurostimulation in clinical practice.
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Affiliation(s)
- D C W Klooster
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - A J A de Louw
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - A P Aldenkamp
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - R M H Besseling
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - R M C Mestrom
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - S Carrette
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - S Zinger
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - J W M Bergmans
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - W H Mess
- Departments of Clinical Neurophysiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - K Vonck
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - E Carrette
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - L E M Breuer
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands.
| | - A Bernas
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - A G Tijhuis
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - P Boon
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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Wolf ME, Blahak C, Krauss JK. The Importance of Checking Impedance: Misinterpretation of Deep Brain Stimulation Dysfunction as Epilepsy. Mov Disord Clin Pract 2016; 3:206-208. [DOI: 10.1002/mdc3.12267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/01/2015] [Accepted: 09/04/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Marc E. Wolf
- Department of Neurology; Universitätsmedizin Mannheim; University of Heidelberg; Mannheim Germany
| | - Christian Blahak
- Department of Neurology; Universitätsmedizin Mannheim; University of Heidelberg; Mannheim Germany
| | - Joachim K. Krauss
- Department of Neurosurgery; Hannover Medical School; Hannover Germany
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21
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Klinger NV, Mittal S. Clinical efficacy of deep brain stimulation for the treatment of medically refractory epilepsy. Clin Neurol Neurosurg 2016; 140:11-25. [DOI: 10.1016/j.clineuro.2015.11.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 10/26/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
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22
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Boccard SGJ, Pereira EAC, Aziz TZ. Deep brain stimulation for chronic pain. J Clin Neurosci 2015; 22:1537-43. [PMID: 26122383 DOI: 10.1016/j.jocn.2015.04.005] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/11/2015] [Indexed: 11/29/2022]
Abstract
Deep brain stimulation (DBS) is a neurosurgical intervention popularised in movement disorders such as Parkinson's disease, and also reported to improve symptoms of epilepsy, Tourette's syndrome, obsessive compulsive disorders and cluster headache. Since the 1950s, DBS has been used as a treatment to relieve intractable pain of several aetiologies including post stroke pain, phantom limb pain, facial pain and brachial plexus avulsion. Several patient series have shown benefits in stimulating various brain areas, including the sensory thalamus (ventral posterior lateral and medial), the periaqueductal and periventricular grey, or, more recently, the anterior cingulate cortex. However, this technique remains "off label" in the USA as it does not have Federal Drug Administration approval. Consequently, only a small number of surgeons report DBS for pain using current technology and techniques and few regions approve it. Randomised, blinded and controlled clinical trials that may use novel trial methodologies are desirable to evaluate the efficacy of DBS in patients who are refractory to other therapies. New imaging techniques, including tractography, may help optimise electrode placement and clinical outcome.
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Affiliation(s)
- Sandra G J Boccard
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK.
| | - Erlick A C Pereira
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Tipu Z Aziz
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
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Levy RM, Harvey RL, Kissela BM, Winstein CJ, Lutsep HL, Parrish TB, Cramer SC, Venkatesan L. Epidural Electrical Stimulation for Stroke Rehabilitation: Results of the Prospective, Multicenter, Randomized, Single-Blinded Everest Trial. Neurorehabil Neural Repair 2015; 30:107-19. [PMID: 25748452 DOI: 10.1177/1545968315575613] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This prospective, single-blinded, multicenter study assessed the safety and efficacy of electrical epidural motor cortex stimulation (EECS) in improving upper limb motor function of ischemic stroke patients with moderate to moderately severe hemiparesis. METHODS Patients ≥ 4 months poststroke were randomized 2:1 to an investigational (n = 104) or control (n = 60) group, respectively. Investigational patients were implanted (n = 94) with an epidural 6-contact lead perpendicular to the primary motor cortex and a pulse generator. Both groups underwent 6 weeks of rehabilitation, but EECS was delivered to investigational patients during rehabilitation. The primary efficacy endpoint (PE) was defined as attaining a minimum improvement of 4.5 points in the upper extremity Fugl-Meyer (UEFM) scale as well as 0.21 points in the Arm Motor Ability Test (AMAT) 4 weeks postrehabilitation. Follow-up assessments were performed 1, 4, 12, and 24 weeks postrehabilitation. Safety was evaluated by monitoring adverse events (AEs) that occurred between enrollment and the end of rehabilitation. RESULTS Primary intent-to-treat analysis showed no group differences at 4 weeks, with PE being met by 32% and 29% of investigational and control patients, respectively (P = .36). Repeated-measures secondary analyses revealed no significant treatment group differences in mean UEFM or AMAT scores. However, post hoc comparisons showed that a greater proportion of investigational (39%) than control (15%) patients maintained or achieved PE (P = .003) at 24 weeks postrehabilitation. Investigational group mean AMAT scores also improved significantly (P < .05) when compared to the control group at 24 weeks postrehabilitation. Post hoc analyses also showed that 69% (n = 9/13) of the investigational patients who elicited movement thresholds during stimulation testing met PE at 4 weeks, and mean UEFM and AMAT scores was also significantly higher (P < .05) in this subgroup at the 4-, 12-, and 24-week assessments when compared to the control group. Headache (19%), pain (13%), swelling (7%), and infection (7%) were the most commonly observed implant procedure-related AEs. Overall, there were 11 serious AEs in 9 investigational group patients (7 procedure related, 4 anesthesia related). CONCLUSIONS The primary analysis pertaining to efficacy of EECS during upper limb motor rehabilitation in chronic stroke patients was negative at 4 weeks postrehabilitation. A better treatment response was observed in a subset of patients eliciting stimulation induced upper limb movements during motor threshold assessments performed prior to each rehabilitation session. Post hoc comparisons indicated treatment effect differences at 24 weeks, with the control group showing significant decline in the combined primary outcome measure relative to the investigational group. These results have the potential to inform future chronic stroke rehabilitation trial design.
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Affiliation(s)
| | - Richard L Harvey
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA The Rehabilitation Institute of Chicago, Chicago, IL, USA
| | | | | | | | - Todd B Parrish
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Abstract
Deep brain stimulation (DBS) has provided remarkable therapeutic benefits for people with a variety of neurological disorders. Despite the uncertainty of the precise mechanisms underlying its efficacy, DBS is clinically effective in improving motor function of essential tremor, Parkinson's disease and primary dystonia and in relieving obsessive-compulsive disorder. Recently, this surgical technique has continued to expand to other numerous neurological diseases with encouraging results. This review highlighted the current and potential future clinical applications of DBS.
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Affiliation(s)
- X L Chen
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Y Y Xiong
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - G L Xu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - X F Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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25
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Seijo F, Alvarez de Eulate Beramendi S, Santamarta Liébana E, Lozano Aragoneses B, Saiz Ayala A, Fernández de León R, Alvarez Vega MA. Surgical adverse events of deep brain stimulation in the subthalamic nucleus of patients with Parkinson's disease. The learning curve and the pitfalls. Acta Neurochir (Wien) 2014; 156:1505-12; discussion 1512. [PMID: 24752724 DOI: 10.1007/s00701-014-2082-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Several surgical adverse events (SAEs) have been associated with Deep Brain Stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's Disease (PD) patients, leading to certain confusion about the risk/benefit ratio of this technique, and giving rise to the need of more and more extensive control studies over longer periods. The aim of this article is to identify and quantify the factors associated with the most frequent AEs from STN DBS in PD-diagnosed patients. METHODS The following variables were studied: aborted procedure, misplaced leads, intracranial haemorrhage, and seizures. This study was carried out in 233 patients diagnosed with PD, with 455 STN electrodes implanted and follow-up after 7 (8-14) years follow up. RESULTS A total amount of 56 SAEs occurred in 49 patients (11.76 % of total procedures, 12.31 % of implanted leads, 21.03 % of patients). SAEs were: five aborted procedures, 26 misplaced leads, ten intracranial haemorrhages, and 15 seizures. Of all the SAEs, long-term effects only happened in two cases of hemiparesis caused by intracranial haemorrhage; the other SAEs were reversible and didn't leave any long-term clinical consequences (0.42 % of procedures, 0.44 % of leads, and 0.86 % of patients). CONCLUSIONS STN DBS in PD patients is a safe surgical procedure, with good risk/benefit ratios: procedure reliability/correct lead implantation in 95.59 %, 0 mortality/implanted lead, 0.12 morbidity/implanted lead, and 0.0043 neurological sequelae/implanted lead.
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26
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Parmar VK, Gee L, Smith H, Pilitsis JG. Supraspinal stimulation for treatment of refractory pain. Clin Neurol Neurosurg 2014; 123:155-63. [PMID: 24956545 DOI: 10.1016/j.clineuro.2014.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 05/21/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
Refractory pain syndromes often have far reaching effects and are quite a challenge for primary care providers and specialists alike to treat. With the help of site-specific neuromodulation and appropriate patient selection these difficult to treat pain syndromes may be managed. In this article, we focus on supraspinal stimulation (SSS) for treatment of intractable pain and discuss off-label uses of deep brain stimulation (DBS) and motor cortex stimulation (MCS) in context to emerging indications in neuromodulation. Consideration for neuromodulatory treatment begins with rigorous patient selection based on exhaustive conservative management, elimination of secondary gains, and a proper psychology evaluation. Trial stimulation prior to DBS is nearly always performed while trial stimulation prior to MCS surgery is symptom dependent. Overall, a review of the literature demonstrates that DBS should be considered for refractory conditions including nociceptive/neuropathic pain, phantom limb pain, and chronic cluster headache (CCH). MCS should be considered primarily for trigeminal neuropathic pain (TNP) and central pain. DBS outcome studies for post-stroke pain as well as MCS studies for complex regional pain syndrome (CRPS) show more modest results and are also discussed in detail.
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Affiliation(s)
- V K Parmar
- Division of Neurosurgery, Albany Medical College, Albany, NY 12208, USA
| | - L Gee
- Division of Neurosurgery, Albany Medical College, Albany, NY 12208, USA
| | - H Smith
- Department of Anesthesia, Albany Medical College, Albany, NY 12208, USA
| | - J G Pilitsis
- Division of Neurosurgery, Albany Medical College, Albany, NY 12208, USA; Center for Neuropharmacology and Neuroscience, Albany Medical College, Albany NY 12208, USA.
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Tarazi FI, Sahli ZT, Wolny M, Mousa SA. Emerging therapies for Parkinson's disease: from bench to bedside. Pharmacol Ther 2014; 144:123-33. [PMID: 24854598 DOI: 10.1016/j.pharmthera.2014.05.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 05/01/2014] [Indexed: 02/08/2023]
Abstract
The prevalence of Parkinson's disease (PD) increases with age and is projected to increase in parallel to the rising average age of the population. The disease can have significant health-related, social, and financial implications not only for the patient and the caregiver, but for the health care system as well. While the neuropathology of this neurodegenerative disorder is fairly well understood, its etiology remains a mystery, making it difficult to target therapy. The currently available drugs for treatment provide only symptomatic relief and do not control or prevent disease progression, and as a result patient compliance and satisfaction are low. Several emerging pharmacotherapies for PD are in different stages of clinical development. These therapies include adenosine A2A receptor antagonists, glutamate receptor antagonists, monoamine oxidase inhibitors, anti-apoptotic agents, and antioxidants such as coenzyme Q10, N-acetyl cysteine, and edaravone. Other emerging non-pharmacotherapies include viral vector gene therapy, microRNAs, transglutaminases, RTP801, stem cells and glial derived neurotrophic factor (GDNF). In addition, surgical procedures including deep brain stimulation, pallidotomy, thalamotomy and gamma knife surgery have emerged as alternative interventions for advanced PD patients who have completely utilized standard treatments and still suffer from persistent motor fluctuations. While several of these therapies hold much promise in delaying the onset of the disease and slowing its progression, more pharmacotherapies and surgical interventions need to be investigated in different stages of PD. It is hoped that these emerging therapies and surgical procedures will strengthen our clinical armamentarium for improved treatment of PD.
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Affiliation(s)
- F I Tarazi
- Department of Psychiatry and Neuroscience Program, Harvard Medical School, McLean Hospital, Belmont, MA 02478, USA.
| | - Z T Sahli
- Department of Psychiatry and Neuroscience Program, Harvard Medical School, McLean Hospital, Belmont, MA 02478, USA; School of Medicine, American University of Beirut, Beirut, Lebanon
| | - M Wolny
- The Pharmaceutical Research Institute at Albany College of Pharmacy and Health Sciences, Rensselaer, NY 12144, USA
| | - S A Mousa
- The Pharmaceutical Research Institute at Albany College of Pharmacy and Health Sciences, Rensselaer, NY 12144, USA
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Abstract
Neurostimulation enables adjustable and reversible modulation of disease symptoms, including those of epilepsy. Two types of brain neuromodulation, comprising anterior thalamic deep brain stimulation and responsive neurostimulation at seizure foci, are supported by Class I evidence of effectiveness, and many other sites in the brain have been targeted in small trials of neurostimulation therapy for seizures. Animal studies have mainly assisted in the identification of potential neurostimulation sites and parameters, but much of the clinical work is only loosely based on fundamental principles derived from the laboratory, and the mechanisms by which brain neurostimulation reduces seizures remain poorly understood. The benefits of stimulation tend to increase over time, with maximal effect seen typically 1-2 years after implantation. Typical reductions of seizure frequency are approximately 40% acutely, and 50-69% after several years. Seizure intensity might also be reduced. Complications from brain neurostimulation are mainly associated with the implantation procedure and hardware, including stimulation-related paraesthesias, stimulation-site infections, electrode mistargeting and, in some patients, triggered seizures or even status epilepticus. Further preclinical and clinical experience with brain stimulation surgery should lead to improved outcomes by increasing our understanding of the optimal surgical candidates, sites and parameters.
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Affiliation(s)
- Robert S Fisher
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 300 Pasteur Drive, Room A343, Stanford, CA 94305-5235, USA
| | - Ana Luisa Velasco
- Clinica de Epilepsia, Hospital General de México OD, Calle Dr. Balmis No. 148, Col. Doctores, Cuauhtémoc, 06726 Mexico City, Mexico
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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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30
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Petrossian MT, Paul LR, Multhaupt-Buell TJ, Eckhardt C, Hayes MT, Duhaime AC, Eskandar EN, Sharma N. Pallidal deep brain stimulation for dystonia: a case series. J Neurosurg Pediatr 2013; 12:582-7. [PMID: 24093589 PMCID: PMC6768427 DOI: 10.3171/2013.8.peds13134] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Pallidal deep brain stimulation (DBS) is a treatment option for those with early-onset dystonia. However, there are limited data on long-term outcome and treatment complications. The authors report on the short- and long-term effects of pallidal DBS in a cohort of patients with early-onset dystonia. METHODS Fourteen consecutive pediatric patients with early-onset dystonia were systematically evaluated and treated. The duration of follow-up ranged from 16 to 84 months. RESULTS There were no immediate postoperative complications. At last follow-up, 12 of the 14 patients displayed a significant decline in the Burke-Fahn-Marsden Dystonia Rating Scale motor subscale score, with an average decrease of 62% ± 8.4%. The most common hardware complication was lead fracture (14.3%). CONCLUSIONS These data provide further evidence that DBS is a safe and effective treatment for those with earlyonset dystonia.
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Affiliation(s)
- Melita T. Petrossian
- Department of Neurology, Brigham and Women’s Hospital;,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Lisa R. Paul
- Department of Neurology, Brigham and Women’s Hospital;,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Christine Eckhardt
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Emad N. Eskandar
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Nutan Sharma
- Department of Neurology, Brigham and Women’s Hospital;,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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31
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Mehanna R, Lai EC. Deep brain stimulation in Parkinson's disease. Transl Neurodegener 2013; 2:22. [PMID: 24245947 PMCID: PMC4177536 DOI: 10.1186/2047-9158-2-22] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 11/11/2013] [Indexed: 11/10/2022] Open
Abstract
For the last 50 years, levodopa has been the cornerstone of Parkinson's disease management. However, a majority of patients develop motor complications a few years after therapy onset. Deep brain stimulation has been approved by the FDA as an adjunctive treatment in Parkinson disease, especially aimed at controlling these complications. However, the exact mechanism of action of deep brain stimulation, the best nucleus to target as well as the best timing for surgery are still debatable. We here provide an in-depth and critical review of the current literature on this topic.
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Affiliation(s)
| | - Eugene C Lai
- Department of Neurology, Houston Methodist Neurological Institute, 6560 Fannin, Suite 802, Houston 77030, TX, USA.
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32
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Abstract
For the last 50 years, levodopa has been the cornerstone of Parkinson's disease management. However, a majority of patients develop motor complications a few years after therapy onset. Deep brain stimulation has been approved by the FDA as an adjunctive treatment in Parkinson disease, especially aimed at controlling these complications. However, the exact mechanism of action of deep brain stimulation, the best nucleus to target as well as the best timing for surgery are still debatable. We here provide an in-depth and critical review of the current literature on this topic.
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Affiliation(s)
| | - Eugene C Lai
- Department of Neurology, Houston Methodist Neurological Institute, 6560 Fannin, Suite 802, Houston 77030, TX, USA.
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33
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Abstract
Deep brain stimulation (DBS) is a method of treatment utilized to control medically refractory epilepsy (RE). Patients with medically refractory epilepsy who do not achieve satisfactory control of seizures with pharmacological treatment or surgical resection of the epileptic focus and those who do not qualify for surgery could benefit from DBS. The most frequently used stereotactic targets for DBS are the anterior thalamic nucleus, subthalamic nucleus, central-medial thalamic nucleus, hippocampus, amygdala and cerebellum. The DBS is believed to be an effective method of treatment for various types of epilepsy among adults and adolescents. Side effects may be associated with implantation of electrodes and with the stimulation itself. An increasing number of publications and growing interest in DBS application for RE may result in standardization of the qualification and treatment protocol for RE with DBS.
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Affiliation(s)
- Tomasz Tykocki
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tomasz Mandat
- Department of Neurosurgery, Institute of Oncology, Warsaw, Poland
| | | | - Henryk Koziara
- Department of Neurosurgery, Institute of Oncology, Warsaw, Poland
| | - Paweł Nauman
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
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Yang YJ, Jhang SW, Chen CM, Chen YH, Cheng CY. Functional preservation of deep brain stimulation electrodes after brain shift induced by traumatic subdural haematoma – case report. Br J Neurosurg 2012; 27:128-9. [DOI: 10.3109/02688697.2012.707703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Michael S Okun
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, USA.
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Erickson KM, Cole DJ. Anesthetic considerations for awake craniotomy for epilepsy and functional neurosurgery. Anesthesiol Clin 2012; 30:241-268. [PMID: 22901609 DOI: 10.1016/j.anclin.2012.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The two most common neurosurgical procedures that call for an awake patient include epilepsy surgery and functional neurosurgery. Monitoring patients in the awake state allows more aggressive resection of epileptogenic foci in functionally important brain regions. Careful patient selection and preparation combined with attentive monitoring and anticipation of events are fundamental to a smooth awake procedure. Current pharmacologic agents and techniques at the neuroanesthesiologist's disposal facilitate an increasing number of procedures performed in awake patients.
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Affiliation(s)
- Kirstin M Erickson
- Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street SE, Rochester, MN 55901, USA.
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Intracranial electrodes in the presurgical evaluation of epilepsy. Neurol Sci 2012; 33:723-9. [PMID: 22460695 DOI: 10.1007/s10072-012-1020-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
The resection of the epileptogenic area of brain is very important and useful for the treatment of uncontrolled epilepsy, especially for the patients with stereotyped partial seizures. The critical point for successful epilepsy surgery is the precise identification of epileptogenic zone. Actually, we cannot precisely localize the epileptogenic zone in about 25 % of patient with refractory seizures based on the noninvasive examination; thus for these patients, we mainly use the intracranial EEG to localize the epileptogenic zone which could be useful in 10-15 % of surgical candidates. The intracranial electrodes which are most used currently are depth electrodes, subdural strip electrodes, and subdural grid electrodes. The subject of this paper is to discuss and compare the indications, construction, insertion, interpretation, limitations, risks and accuracy of each of these methods.
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Bakay RAE, Vannemreddy PSSV. Deep brain stimulation and seizures. J Neurosurg 2012; 116:926; author reply 926-7. [PMID: 22242674 DOI: 10.3171/2011.8.jns111461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Pouratian N, Reames DL, Frysinger R, Elias WJ. Comprehensive analysis of risk factors for seizures after deep brain stimulation surgery. J Neurosurg 2011; 115:310-5. [DOI: 10.3171/2011.4.jns102075] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The aim of this study was to assess risk factors for postoperative seizures after deep brain stimulation (DBS) lead implantation surgery and the impact of such seizures on length of stay and discharge disposition.
Methods
The authors reviewed a consecutive series of 161 cases involving patients who underwent implantation of 288 electrodes for treatment of movement disorders at a single institution to determine the absolute risk of postoperative seizures, to describe the timing and type of seizures, to identify statistically significant risk factors for seizures, and to determine whether there are possible indications for seizure prophylaxis after DBS lead implantation. The electronic medical records were reviewed to identify demographic details, medical history, operative course, and postoperative outcomes and complications. To evaluate significant associations between potential risk factors and postoperative seizures, both univariate and multivariate analyses were performed.
Results
Seven (4.3%) of 161 patients experienced postoperative seizures, all of which were documented to have been generalized tonic-clonic seizures. In 5 (71%) of 7 cases, patients only experienced a single seizure. Similarly, in 5 of 7 cases, patients experienced seizures within 24 hours of surgery. In 6 (86%) of the 7 cases, seizures occurred within 48 hours of surgery. Univariate analysis identified 3 significant associations (or risk factors) for postoperative seizures: abnormal findings on postoperative imaging (hemorrhage, edema, and or ischemia; p < 0.001), age greater than 60 years (p = 0.021), and transventricular electrode trajectories (p = 0.023). The only significant factor identified on multivariate analysis was abnormal findings on postoperative imaging (p < 0.0001, OR 50.4, 95% CI 5.7–444.3). Patients who experienced postoperative seizures had a significantly longer length of stay than those who were seizure free (mean ± SD 5.29 ± 3.77 days vs 2.38 ± 2.38 days; p = 0.002, Student 2-tailed t-test). Likewise, final discharge to home was significantly less likely in patients who experienced seizures after implantation (43%) compared with those patients who did not (92%; p = 0.00194, Fisher exact test).
Conclusions
These results affirm that seizures are an uncommon complication of DBS surgery and generally occur within 48 hours of surgery. The results also indicate that hemorrhage, edema, or ischemia on postoperative images (“abnormal” imaging findings) increases the relative risk of postoperative seizures by 30- to 50-fold, providing statistical credence to the long-held assumption that seizures are associated with intracranial vascular events. Even in the setting of a postimplantation imaging abnormality, long-term anticonvulsant therapy will not likely be required because none of our patients developed chronic epilepsy.
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Affiliation(s)
- Nader Pouratian
- 1Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California; and
| | - Davis L. Reames
- 2Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Robert Frysinger
- 2Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - W. Jeff Elias
- 2Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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Johnson RD, Qadri SR, Joint C, Moir L, Green AL, Aziz TZ. Perioperative seizures following deep brain stimulation in patients with multiple sclerosis. Br J Neurosurg 2010; 24:289-90. [DOI: 10.3109/02688690903577631] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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