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Ha J, Lee D, Ahn JH, Cho JW, Lee JI, Fasano A, Park SJ, Youn J. Deep Brain Stimulation in Patients with Cardiac Implantable Electronic Devices: Pulse Width Pitfalls. Mov Disord Clin Pract 2024; 11:909-911. [PMID: 38779742 PMCID: PMC11233839 DOI: 10.1002/mdc3.14066] [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: 12/04/2023] [Accepted: 04/03/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Jongmok Ha
- Department of NeurologySamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
- Neuroscience Center, Samsung Medical CenterSeoulRepublic of Korea
| | - Dongyeong Lee
- Department of NeurologySamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
- Neuroscience Center, Samsung Medical CenterSeoulRepublic of Korea
| | - Jong Hyeon Ahn
- Department of NeurologySamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
- Neuroscience Center, Samsung Medical CenterSeoulRepublic of Korea
| | - Jin Whan Cho
- Department of NeurologySamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
- Neuroscience Center, Samsung Medical CenterSeoulRepublic of Korea
| | - Jung Il Lee
- Department of NeurosurgerySamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health NetworkTorontoOntarioCanada
- Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Brain Institute, NeuroscienceTorontoOntarioCanada
| | - Seung Jung Park
- Department of CardiologySamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Jinyoung Youn
- Department of NeurologySamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
- Neuroscience Center, Samsung Medical CenterSeoulRepublic of Korea
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Barbosa RMG, Soares MC, Portela DMMC, Guimarães TG, Cury RG. New Perspectives of Deep Brain Stimulation Indications for Parkinson's Disease: A Critical Review. Brain Sci 2024; 14:638. [PMID: 39061379 PMCID: PMC11274985 DOI: 10.3390/brainsci14070638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Deep Brain Stimulation (DBS) is an effective treatment option for patients with dopaminergic complications of Parkinson's disease (PD) and drug-refractory PD tremor. However, DBS and its indications can be challenging, and they are not often debated in the medical community. Through a critical narrative review, the objective of this paper is to improve the comprehension of DBS indications and help to solve the puzzle that this process can be. Proper patient selection is the first step for a good surgical outcome. In this review, then, relevant considerations are discussed, involving PD genes, PD phenotypes, indications of early stages, non-motor symptoms, neuroimaging predictors, comorbidities, and age. Individualized approaches are encouraged, including clinical and radiological factors. Social support during the whole follow-up and expectations alignment are necessary through this process and are also debated.
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Affiliation(s)
- Renata Montes Garcia Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil; (R.M.G.B.); (M.C.S.); (T.G.G.)
| | - Miriam Carvalho Soares
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil; (R.M.G.B.); (M.C.S.); (T.G.G.)
| | - Denise Maria Meneses Cury Portela
- Movement Disorders Center, Department of Neurology, School of Medicine, Centro Universitário Uninovafapi (UNINOVAFAPI), Teresina 64073505, Brazil;
| | - Thiago Gonçalves Guimarães
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil; (R.M.G.B.); (M.C.S.); (T.G.G.)
| | - Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil; (R.M.G.B.); (M.C.S.); (T.G.G.)
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Runge J, Cassini Ascencao L, Blahak C, Kinfe TM, Schrader C, Wolf ME, Saryyeva A, Krauss JK. Deep brain stimulation in patients on chronic antiplatelet or anticoagulation treatment. Acta Neurochir (Wien) 2021; 163:2825-2831. [PMID: 34342730 PMCID: PMC8437860 DOI: 10.1007/s00701-021-04931-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the aging society, many patients with movement disorders, pain syndromes, or psychiatric disorders who are candidates for deep brain stimulation (DBS) surgery suffer also from cardiovascular co-morbidities that require chronic antiplatelet or anticoagulation treatment. Because of a presumed increased risk of intracranial hemorrhage during or after surgery and limited knowledge about perioperative management, chronic antiplatelet or anticoagulation treatment often has been considered a relative contraindication for DBS. Here, we evaluate whether or not there is an increased risk for intracranial hemorrhage or thromboembolic complications in patients on chronic treatment (paused for surgery or bridged with subcutaneous heparin) as compared to those without. METHODS Out of a series of 465 patients undergoing functional stereotactic neurosurgery, 34 patients were identified who were on chronic treatment before and after receiving DBS. In patients with antiplatelet treatment, medication was stopped in the perioperative period. In patients with vitamin K antagonists or novel oral anticoagulants (NOACs), heparin was used for bridging. All patients had postoperative stereotactic CT scans, and were followed up for 1 year after surgery. RESULTS In patients on chronic antiplatelet or anticoagulation treatment, intracranial hemorrhage occurred in 2/34 (5.9%) DBS surgeries, whereas the rate of intracranial hemorrhage was 15/431 (3.5%) in those without, which was statistically not significant. Implantable pulse generator pocket hematomas were seen in 2/34 (5.9%) surgeries in patients on chronic treatment and in 4/426 (0.9%) without. There were only 2 instances of thromboembolic complications which both occurred in patients without chronic treatment. There were no hemorrhagic complications during follow-up for 1 year. CONCLUSIONS DBS surgery in patients on chronic antiplatelet or anticoagulation treatment is feasible. Also, there was no increased risk of hemorrhage in the first year of follow-up after DBS surgery. Appropriate patient selection and standardized perioperative management are necessary to reduce the risk of intracranial hemorrhage and thromboembolic complications.
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Affiliation(s)
- Joachim Runge
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Luisa Cassini Ascencao
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Christian Blahak
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
- Department of Neurology, Ortenau Klinikum Lahr-Ettenheim, Lahr, Germany
| | - Thomas M Kinfe
- Department of Neurosurgery, Division of Functional Neurosurgery and Stereotaxy, Friedrich-Alexander University, Erlangen-Nürnberg, Erlangen, Germany
| | | | - Marc E Wolf
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
- Department of Neurology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Assel Saryyeva
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Center of Systems Neuroscience, Hannover, Germany
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Akhoundi FH, Contarino MF, Fasano A, Vaidyanathan J, Ziaee M, Tabatabaee SN, Rohani M. Coexistence of deep brain stimulators and cardiac implantable electronic devices: A systematic review of safety. Parkinsonism Relat Disord 2021; 88:129-135. [PMID: 34011446 DOI: 10.1016/j.parkreldis.2021.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/25/2022]
Abstract
As the number of patients implanted with deep brain stimulation systems increases, coexistence with cardiac implantable electronic devices (CIEDs) poses questions about safety. We systematically reviewed the literature on coexisting DBS and CIED. Eighteen reports of 34 patients were included. Device-device interactions were reported in 6 patients. Sources of complications were extensively reviewed and cautious measures which could be considered as part of a standard checklist for careful consideration are suggested.
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Affiliation(s)
- Fahimeh H Akhoundi
- Division of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - M Fiorella Contarino
- Haga Teaching Hospital, Department of Neurology, The Hague, the Netherlands; Leiden University Medical Center, Department of Neurology, Leiden, the Netherlands
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | | | - Mahsa Ziaee
- Division of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Rohani
- Division of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Azevedo P, Aquino CC, Fasano A. Surgical Management of Parkinson's Disease in the Elderly. Mov Disord Clin Pract 2021; 8:500-509. [PMID: 33981782 DOI: 10.1002/mdc3.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 11/09/2022] Open
Abstract
Background Deep Brain Stimulation (DBS) is an increasingly popular therapy for Parkinson's Disease (PD). Despite the experience gained over time with DBS of either the subthalamus or the globus pallidus pars interna, there is still no consensus regarding the age limit for DBS indication. Objectives This narrative review of the literature discusses the issues of age and DBS, emphasizing the critical need for good quality evidence to support the surgical management of elderly patients with PD. Methods We searched PubMed using the terms Parkinson's Disease; Parkinson's Disease therapy; deep brain stimulation; antiparkinsonian agents therapeutic use; age factors; aged; aged, 80 and over; middle aged; treatment outcome; and risk assessments. Results We identified several limitations of the available evidence, such as under-representation of older patients in DBS studies, small sample sizes in studies with older participants, heterogeneity of outcomes, and conflicting results. Conclusions Despite preliminary suggestions that age might affect the outcomes of DBS, the evidence to support the hypothesis of age as an independent predictor of DBS outcomes is limited and results are controversial. Ultimately, finding an age-independent biomarker predicting DBS outcome is the final goal to expand this powerful treatment to all patients age in an effective and safe manner.
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Affiliation(s)
- Paula Azevedo
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology University of Toronto Toronto Ontario Canada
| | - Camila C Aquino
- Department of Clinical Neurosciences University of Calgary Calgary Alberta Canada.,Hotchkiss Brain Institute, University of Calgary Calgary Alberta Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology University of Toronto Toronto Ontario Canada.,Krembil Brain Institute Toronto Ontario Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA) Toronto Ontario Canada
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Nayak HM, Sauser E, Xie T. Interference of subcutaneous implantable cardioverter defibrillator by deep brain stimulation. Parkinsonism Relat Disord 2020; 81:75-77. [PMID: 33075699 DOI: 10.1016/j.parkreldis.2020.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Hemal M Nayak
- Center for Arrhythmia Care, University of Chicago Medicine, Chicago, IL, 60637, USA
| | - Emilie Sauser
- Center for Arrhythmia Care, University of Chicago Medicine, Chicago, IL, 60637, USA
| | - Tao Xie
- Movement Disorder Clinic and Deep Brain Stimulation Program, Department of Neurology, University of Chicago Medicine, Chicago, IL, 60637, USA.
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