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Mohamed AA, Faragalla S, Khan A, Flynn G, Rainone G, Johansen PM, Lucke-Wold B. Neurosurgical and pharmacological management of dystonia. World J Psychiatry 2024; 14:624-634. [PMID: 38808085 PMCID: PMC11129150 DOI: 10.5498/wjp.v14.i5.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
Dystonia characterizes a group of neurological movement disorders characterized by abnormal muscle movements, often with repetitive or sustained contraction resulting in abnormal posturing. Different types of dystonia present based on the affected body regions and play a prominent role in determining the potential efficacy of a given intervention. For most patients afflicted with these disorders, an exact cause is rarely identified, so treatment mainly focuses on symptomatic alleviation. Pharmacological agents, such as oral anticholinergic administration and botulinum toxin injection, play a major role in the initial treatment of patients. In more severe and/or refractory cases, focal areas for neurosurgical intervention are identified and targeted to improve quality of life. Deep brain stimulation (DBS) targets these anatomical locations to minimize dystonia symptoms. Surgical ablation procedures and peripheral denervation surgeries also offer potential treatment to patients who do not respond to DBS. These management options grant providers and patients the ability to weigh the benefits and risks for each individual patient profile. This review article explores these pharmacological and neurosurgical management modalities for dystonia, providing a comprehensive assessment of each of their benefits and shortcomings.
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Affiliation(s)
- Ali Ahmed Mohamed
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Steven Faragalla
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Asad Khan
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Garrett Flynn
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Gersham Rainone
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL 33606, United States
| | - Phillip Mitchell Johansen
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL 33606, United States
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611, United States
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Kovács P, Kitka T, Bali ZK, Nagy LV, Bodó A, Kovács-Öller T, Péterfi Z, Hernádi I. Chemogenetic inhibition of the lateral hypothalamus effectively reduces food intake in rats in a translational proof-of-concept study. Sci Rep 2024; 14:11402. [PMID: 38762561 PMCID: PMC11102470 DOI: 10.1038/s41598-024-62014-1] [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: 02/12/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024] Open
Abstract
Despite the therapeutic potential of chemogenetics, the method lacks comprehensive preclinical validation, hindering its progression to human clinical trials. We aimed to validate a robust but simple in vivo efficacy assay in rats which could support chemogenetic drug discovery by providing a quick, simple and reliable animal model. Key methodological parameters such as adeno-associated virus (AAV) serotype, actuator drug, dose, and application routes were investigated by measuring the food-intake-reducing effect of chemogenetic inhibition of the lateral hypothalamus (LH) by hM4D(Gi) designer receptor stimulation. Subcutaneous deschloroclozapine in rats transfected with AAV9 resulted in a substantial reduction of food-intake, comparable to the efficacy of exenatide. We estimated that the effect of deschloroclozapine lasts 1-3 h post-administration. AAV5, oral administration of deschloroclozapine, and clozapine-N-oxide were also effective but with slightly less potency. The strongest effect on food-intake occurred within the first 30 min after re-feeding, suggesting this as the optimal experimental endpoint. This study demonstrates that general chemogenetic silencing of the LH can be utilized as an optimal, fast and reliable in vivo experimental model for conducting preclinical proof-of-concept studies in order to validate the in vivo effectiveness of novel chemogenetic treatments. We also hypothesize based on our results that universal LH silencing with existing and human translatable genetic neuroengineering techniques might be a viable strategy to affect food intake and influence obesity.
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Affiliation(s)
- Péter Kovács
- VRG Therapeutics, Füvészkert utca 3., Budapest, 1083, Hungary
| | - Tamás Kitka
- VRG Therapeutics, Füvészkert utca 3., Budapest, 1083, Hungary
| | - Zsolt Kristóf Bali
- Grastyán Endre Translational Research Centre, University of Pécs, 6 Ifjúság str., Pécs, 7624, Hungary.
- Translational Neuroscience Research Group, Centre for Neuroscience, Szentágothai Research Centre, University of Pécs, 20 Ifjúság str., Pécs, 7624, Hungary.
| | - Lili Veronika Nagy
- Grastyán Endre Translational Research Centre, University of Pécs, 6 Ifjúság str., Pécs, 7624, Hungary
- Translational Neuroscience Research Group, Centre for Neuroscience, Szentágothai Research Centre, University of Pécs, 20 Ifjúság str., Pécs, 7624, Hungary
- Department of Neurobiology, Faculty of Sciences, University of Pécs, 6 Ifjúság str., Pécs, 7624, Hungary
| | - Angelika Bodó
- Grastyán Endre Translational Research Centre, University of Pécs, 6 Ifjúság str., Pécs, 7624, Hungary
- Translational Neuroscience Research Group, Centre for Neuroscience, Szentágothai Research Centre, University of Pécs, 20 Ifjúság str., Pécs, 7624, Hungary
| | - Tamás Kovács-Öller
- Department of Neurobiology, Faculty of Sciences, University of Pécs, 6 Ifjúság str., Pécs, 7624, Hungary
- Histology and Light Microscopy Core Facility, Szentágothai Research Centre, University of Pécs, 20 Ifjúság str., Pécs, 7624, Hungary
| | - Zalán Péterfi
- VRG Therapeutics, Füvészkert utca 3., Budapest, 1083, Hungary
| | - István Hernádi
- Grastyán Endre Translational Research Centre, University of Pécs, 6 Ifjúság str., Pécs, 7624, Hungary
- Translational Neuroscience Research Group, Centre for Neuroscience, Szentágothai Research Centre, University of Pécs, 20 Ifjúság str., Pécs, 7624, Hungary
- Department of Neurobiology, Faculty of Sciences, University of Pécs, 6 Ifjúság str., Pécs, 7624, Hungary
- Institute of Physiology, Medical School, University of Pécs, 12 Szigeti út, Pécs, 7624, Hungary
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Riis TS, Feldman DA, Vonesh LC, Brown JR, Solzbacher D, Kubanek J, Mickey BJ. Durable effects of deep brain ultrasonic neuromodulation on major depression: a case report. J Med Case Rep 2023; 17:449. [PMID: 37891643 PMCID: PMC10612153 DOI: 10.1186/s13256-023-04194-4] [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: 02/10/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Severe forms of depression have been linked to hyperactivity of the subcallosal cingulate cortex. The ability to stimulate the subcallosal cingulate cortex or associated circuits noninvasively and directly would maximize the number of patients who could receive treatment. To this end, we have developed an ultrasound-based device for effective noninvasive modulation of deep brain circuits. Here we describe an application of this tool to an individual with treatment-resistant depression. CASE PRESENTATION A 30-year-old Caucasian woman with severe treatment-resistant non-psychotic depression was recruited into a clinical study approved by the Institutional Review Board of the University of Utah. The patient had a history of electroconvulsive therapy with full remission but without sustained benefit. Magnetic resonance imaging was used to coregister the ultrasound device to the subject's brain anatomy and to evaluate neural responses to stimulation. Brief, 30-millisecond pulses of low-intensity ultrasound delivered into the subcallosal cingulate cortex target every 4 seconds caused a robust decrease in functional magnetic resonance imaging blood-oxygen-level-dependent activity within the target. Following repeated stimulation of three anterior cingulate targets, the patient's depressive symptoms resolved within 24 hours of the stimulation. The patient remained in remission for at least 44 days afterwards. CONCLUSIONS This case illustrates the potential for ultrasonic neuromodulation to precisely engage deep neural circuits and to trigger a durable therapeutic reset of those circuits. Trial registration ClinicalTrials.gov, NCT05301036. Registered 29 March 2022, https://clinicaltrials.gov/ct2/show/NCT05301036.
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Affiliation(s)
- Thomas S Riis
- Department of Biomedical Engineering, University of Utah, Salt Lake City, USA.
| | - Daniel A Feldman
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, USA
| | - Lily C Vonesh
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, USA
| | - Jefferson R Brown
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, USA
| | - Daniela Solzbacher
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, USA
| | - Jan Kubanek
- Department of Biomedical Engineering, University of Utah, Salt Lake City, USA
| | - Brian J Mickey
- Department of Biomedical Engineering, University of Utah, Salt Lake City, USA
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, USA
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Lu F, Zhao K, Wu Y, Kong Y, Gao Y, Zhang L. Voice-Related Outcomes in Deep Brain Stimulation in Patients with Vocal Tremor: A Systematic Review and Meta-Analysis. J Voice 2023:S0892-1997(23)00302-8. [PMID: 37880051 DOI: 10.1016/j.jvoice.2023.09.027] [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: 07/30/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES The effectiveness of deep brain stimulation (DBS) in treating vocal tremors is currently a subject of debate. To assess the efficacy of DBS therapy in adults with vocal tremors (VT), we analyzed its impact on voice tremor severity, voice-related quality of life, fundamental frequency, voice intensity, and emotional state. METHODS We conducted a systematic review with meta-analysis to investigate the impact of DBS therapy on voice tremor severity, voice-related quality of life, fundamental frequency, voice intensity, and emotional state in adults with vocal tremors (PROSPERO/CRD42023420272). The PubMed, Embase, Cochrane Library, Cochrane Central Register of Controlled Trials databases were searched up to September 20, 2022. Primary outcome measures included voice tremor severity and voice-related quality of life (V-RQOL), while fundamental frequency (F0) and voice intensity, along with emotional state, were selected as secondary outcome indicators. We employed the Cochrane Collaboration's tool for assessing bias risk in randomized trials. Meta-analysis (standardized difference of means and weighted mean differences) and heterogeneity analysis (I2) were performed. RESULTS Our search identified 1186 studies, of which nine studies involving 61 patients met the inclusion criteria. The severity of voice tremor (SMD = -1.08; 95% CI: -1.80 to 0.35; P = 0.02) and V-RQOL (SMD = -1.39; 95% CI: -2.68 to -0.09; P = 0.04) in patients with vocal tremor significantly improved after DBS "on". Subgroup analyses revealed that the stimulation site may contribute to high heterogeneity. Specifically, Vim DBS showed significant improvement in voice tremor severity (SMD = -0.97; 95% CI: -1.84 to -0.09; I2 = 51.01%), while STN DBS did not demonstrate a clear benefit in addressing vocal tremor. There was no significant difference between DBS "on" and DBS "off" in terms of F0, voice intensity, or emotional status. CONCLUSION DBS therapy is effective in enhancing voice quality and voice-related quality of life in patients with vocal tremors. Notably, Vim DBS demonstrates a significant improvement in voice tremor severity, particularly in VT patients with ET and SD.
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Affiliation(s)
- Feiao Lu
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Kun Zhao
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yulun Wu
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yurou Kong
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yongxiang Gao
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Liya Zhang
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Kim A, Kim HJ, Kim A, Kim Y, Kim A, Ong JNA, Park HR, Paek SH, Jeon B. The mortality of patients with Parkinson's disease with deep brain stimulation. Front Neurol 2023; 13:1099862. [PMID: 36726749 PMCID: PMC9885091 DOI: 10.3389/fneur.2022.1099862] [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: 11/16/2022] [Accepted: 12/19/2022] [Indexed: 01/17/2023] Open
Abstract
Background Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in improving motor function in patients with Parkinson's disease (PD). This study aimed to investigate mortality associated with bilateral STN DBS in patients with PD and to assess the factors associated with mortality and causes of death after DBS. Methods We reviewed the medical records of 257 patients with PD who underwent bilateral STN DBS at the Movement Disorder Center at Seoul National University Hospital between March 2005 and November 2018. Patients were evaluated preoperatively, at 3, 6, and 12 months after surgery and annually thereafter. The cause and date of death were obtained from interviews with caregivers or from medical certificates at the last follow-up. Results Of the 257 patients with PD, 48 patients (18.7%) died, with a median time of death of 11.2 years after surgery. Pneumonia was the most common cause of death. Older age of disease onset, preoperative falling score while on medication, and higher preoperative total levodopa equivalent daily dose were associated with a higher risk of mortality in time-dependent Cox regression analysis. Conclusion These results confirm the mortality outcome of STN DBS in patients with advanced PD.
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Affiliation(s)
- Ahro Kim
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Han-Joon Kim
- Department of Neurology, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Aryun Kim
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Yoon Kim
- Department of Neurology, Young Tong Hyo Hospital, Suwon, Republic of Korea
| | - Ahwon Kim
- Department of Neurology, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jed Noel A. Ong
- Department of Neurosciences, Makati Medical Center, Makati, Philippines
| | - Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Sun Ha Paek
- Department of Neurosurgery, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea,Sun Ha Paek ✉
| | - Beomseok Jeon
- Department of Neurology, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea,*Correspondence: Beomseok Jeon ✉
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Yu CP, Tsang CP, Ip YM. Gamma knife radiosurgery versus deep brain stimulation for treatment-refractory depression and obsessive-compulsive disorder: A brief comparative summary. PROGRESS IN BRAIN RESEARCH 2022; 272:33-40. [PMID: 35667805 DOI: 10.1016/bs.pbr.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Both gamma knife surgery (GKS) and deep brain stimulation (DBS) have documented success in management of treatment-refractory major depressive disorder (MDD) and obsessive-compulsive disorder (OCD), but there are no formal randomized controlled trials to compare these treatment modalities in cases of psychiatric illnesses. In this brief review, comparison of GKS and DBS for management of MDD and OCD was done with regard to their efficacy, accompanying risks, reversibility of therapeutic effects, costs, availability, and daily life issues. Currently available evidence does not support the superiority of either evaluated treatment modality over each other in terms of clinical efficacy in cases of MDD and OCD. Nevertheless, with regard to risks, costs, device maintenance, and daily life issues, GKS definitely seems more advantageous. Reversibility of therapeutic effects of DBS is certainly highly attractive, while may be a bit overhyped. In any case, synergy between GKS and DBS for management of mental illnesses lies in the continuing pursuit of improvement and raising the bar of excellence.
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Affiliation(s)
- Chung Ping Yu
- Gamma Knife Centre, Canossa Hospital, Hong Kong, SAR, China; Clinical Neuroscience Centre, Neurosurgery Centre, Hong Kong Sanatorium and Hospital, Hong Kong, SAR, China.
| | - Chun Pong Tsang
- Clinical Neuroscience Centre, Neurosurgery Centre, Hong Kong Sanatorium and Hospital, Hong Kong, SAR, China
| | - Yan Ming Ip
- Psychiatry Services, Canossa Hospital, Hong Kong, SAR, China
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Frey J, Cagle J, Johnson KA, Wong JK, Hilliard JD, Butson CR, Okun MS, de Hemptinne C. Past, Present, and Future of Deep Brain Stimulation: Hardware, Software, Imaging, Physiology and Novel Approaches. Front Neurol 2022; 13:825178. [PMID: 35356461 PMCID: PMC8959612 DOI: 10.3389/fneur.2022.825178] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) has advanced treatment options for a variety of neurologic and neuropsychiatric conditions. As the technology for DBS continues to progress, treatment efficacy will continue to improve and disease indications will expand. Hardware advances such as longer-lasting batteries will reduce the frequency of battery replacement and segmented leads will facilitate improvements in the effectiveness of stimulation and have the potential to minimize stimulation side effects. Targeting advances such as specialized imaging sequences and “connectomics” will facilitate improved accuracy for lead positioning and trajectory planning. Software advances such as closed-loop stimulation and remote programming will enable DBS to be a more personalized and accessible technology. The future of DBS continues to be promising and holds the potential to further improve quality of life. In this review we will address the past, present and future of DBS.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jackson Cagle
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Kara A. Johnson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Joshua K. Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Justin D. Hilliard
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Christopher R. Butson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Coralie de Hemptinne
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- *Correspondence: Coralie de Hemptinne
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Cabral AM, Pereira AA, Vieira MF, Pessôa BL, de Oliveira Andrade A. Prevalence of distinct types of hardware failures related to deep brain stimulation. Neurosurg Rev 2021; 45:1123-1134. [PMID: 34665369 DOI: 10.1007/s10143-021-01673-4] [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: 08/02/2021] [Revised: 09/16/2021] [Accepted: 10/07/2021] [Indexed: 11/24/2022]
Abstract
Deep brain stimulation (DBS) is an effective treatment of several types of neurological conditions, including Parkinson's disease, essential tremor, dystonia, and epilepsy. Despite technological progress in the past 10 years, the number of studies reporting side effects of DBS has increased, mainly due to hardware failures. This review investigated studies published between 2017 and 2021 to identify the prevalence of distinct types of hardware failures related to DBS. In total, fifteen studies were selected for the estimate of the prevalence of five distinct types of hardware failures: high impedance, fracture or failure of the lead or other parts of the implant, skin erosion and infection, lead malposition or migration, and implantable pulse generator (IPG) malfunction. The quality evaluation of the studies suggests a need to report results including populations from distinct regions of the world so that results can be generalized. The objective analysis of the prevalence of hardware failures showed that skin erosion and infection presented the highest prevalence in relation to other hardware failures. Despite the sophistication of the surgical technique of DBS over time, there is a considerable complication rate, about 7 per 100 individuals ([Formula: see text], in which CI is the confidence interval). Future research can also include correlation analysis with the aim of understanding the correlation between distinct hardware failures and variables such as gender, type of disorder, and age.
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Affiliation(s)
- Ariana Moura Cabral
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Postgraduate Program in Electrical and Biomedical Engineering, Federal University of Uberlândia, Campus Santa Mônica - Bloco 1E, Av. Joao Naves de Avila, 2121, Uberlandia, MG, 38408-100, Brazil
| | - Adriano Alves Pereira
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Postgraduate Program in Electrical and Biomedical Engineering, Federal University of Uberlândia, Campus Santa Mônica - Bloco 1E, Av. Joao Naves de Avila, 2121, Uberlandia, MG, 38408-100, Brazil
| | - Marcus Fraga Vieira
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Brazil
| | - Bruno Lima Pessôa
- Postgraduate Program in Neurology, Faculty of Medicine, Federal University of Fluminense, Niterói, Brazil
| | - Adriano de Oliveira Andrade
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Postgraduate Program in Electrical and Biomedical Engineering, Federal University of Uberlândia, Campus Santa Mônica - Bloco 1E, Av. Joao Naves de Avila, 2121, Uberlandia, MG, 38408-100, Brazil
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Wang D, Liu J, Hao Q, Ding H, Liu B, Liu Z, Song H, Ouyang J, Liu R. Experience to prevent wire tethering in deep brain stimulation from a single center. Neurol Res 2021; 43:909-915. [PMID: 34210254 DOI: 10.1080/01616412.2021.1948737] [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] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyze the causes of wire tethering in deep brain stimulation (DBS) and propose ways to prevent it. METHODS A total of 70 consecutive patients (140 electrodes) operated for DBS in our department from September 2017 to December 2019 were analyzed to document wire tethering, respectively, in the initial period (September 2017-June 2018) and the late period (July 2018-December 2019). The patients come back to our clinic 1 month postoperatively to turn on the equipment and followed up any time postoperatively face to face. RESULTS Wire tethering was divided into mild, moderate and severe. The frequency of mild wire tethering was 12.5% (2/16) in the initial period and 9.3% (5/54) in the late period. The frequency of moderate wire tethering was 12.5% (2/16) in the initial period and 3.7% (2/54) in the late period. There was only one patient suffered from severe wire tethering in the initial period and none in the late period. There was a significant difference between the initial (31.3%) and the late (13%) periods in the frequency of total wire tethering. CONCLUSIONS Wire tethering is a rare but serious hardware complication in DBS which should be noteworthy. Improving surgical skill when implanted the extension wire and inventing new material covering extension wire can prevent wire tethering.
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Affiliation(s)
- Dongliang Wang
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Jiayu Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Qingpei Hao
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Hu Ding
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Bo Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Zhi Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Haidong Song
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Jia Ouyang
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Ruen Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
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Kolaya E, Firestein BL. Deep brain stimulation: Challenges at the tissue-electrode interface and current solutions. Biotechnol Prog 2021; 37:e3179. [PMID: 34056871 DOI: 10.1002/btpr.3179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 11/08/2022]
Abstract
Deep brain stimulation (DBS) is used to treat the motor symptoms of Parkinson's disease patients by stimulating the subthalamic nucleus. However, optimization of DBS is still needed since the performance of the neural electrodes is limited by the body's response to the implant. This review discusses the issues with DBS, such as placement of electrodes, foreign body response, and electrode degradation. The current solutions to these technical issues include modifications to electrode material, coatings, and geometry.
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Affiliation(s)
- Emily Kolaya
- Biomedical Engineering Graduate Program, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Bonnie L Firestein
- Department of Cell Biology and Neuroscience, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
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He W, Li H, Lai Y, Wu Y, Wu Y, Ramirez-Zamora A, Yi W, Zhang C. Weight Change After Subthalamic Nucleus Deep Brain Stimulation in Patients With Isolated Dystonia. Front Neurol 2021; 12:632913. [PMID: 33716933 PMCID: PMC7944092 DOI: 10.3389/fneur.2021.632913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/21/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment method for advanced Parkinson's disease (PD) and isolated dystonia and provides marked improvement of major motor symptoms. In addition, non-motor effects have been reported including weight gain (WG) in patients with PD after STN-DBS. However, it is still unclear whether patients with isolated dystonia also experience WG. Methods: Data from 47 patients with isolated dystonia who underwent bilateral STN-DBS surgery between October 2012 and June 2019 were retrospectively collected. The severity of dystonia was assessed via the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). Changes in the body mass index (BMI) and BFMDRS score were analyzed using paired Student's t-tests. Regression analysis was performed to identify factors that affected the BMI after surgery. Results: Postoperative WG was observed in 78.7% of patients. The percentage of overweight and obese patients increased from 25.5% (before STN-DBS) to 48.9% (at the last follow-up). The mean BMI and mean percentage change in BMI increased by 1.32 ± 1.83 kg/m2 (P < 0.001) and 6.28 ± 8.34%, respectively. BMI increased more in female than in male patients. At the last follow-up, BFMDRS movement and disability scores improved by 69.76 ± 33.23% and 65.66 ± 31.41%, respectively (both P < 0.001). The final regression model analysis revealed that sex and preoperative BMI alone were independently associated with BMI change (P < 0.05). Conclusions: STN-DBS is associated with postoperative WG with patients with isolated dystonia. WG is more prominent in female patients and is associated with preoperative weight but not with the efficacy of STN-DBS on motor symptoms.
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Affiliation(s)
- Weibin He
- Department of Neurosurgery, Renmin Hospital, Wuhan University, Wuhan, China
| | - Hongxia Li
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijie Lai
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunhao Wu
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwen Wu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Adolfo Ramirez-Zamora
- Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Wei Yi
- Department of Neurosurgery, Renmin Hospital, Wuhan University, Wuhan, China
| | - Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Doshi PK, Rai N, Das D. Surgical and Hardware Complications of Deep Brain Stimulation-A Single Surgeon Experience of 519 Cases Over 20 Years. Neuromodulation 2021; 25:895-903. [PMID: 33496063 DOI: 10.1111/ner.13360] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/19/2020] [Accepted: 12/21/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Deep brain stimulation (DBS) surgery has its own set of risks and complications. This study from a single center and a single surgeon analyzes various risk factors for complications and tries to establish if there is a learning curve effect in minimizing the complications. MATERIALS AND METHODS A retrospective analysis of 519 patients (1024 leads) who underwent DBS surgery and 232 patients who underwent implantable pulse generator replacement (IPG), by a single surgeon, between the years 1999 and 2019 was performed. Perioperative and hardware related complications were evaluated. RESULTS The follow-up period ranged from six months to 20 years. Surgery-related complications occurred in 46 (8.9%) cases which included confusion in 31 (5.98%), intracerebral hemorrhage in 7 (1.3%), vasovagal attack in 3 (0.58%), respiratory distress in 2 (0.38%), postoperative aggressiveness in 1 (0.19%), and blepharospasm in 2 (0.38%) patients. Complications related to the DBS hardware were found in 35 cases, including erosion and infection in 22 (2.95%), inaccurate lead placement or migration in 6 (0.6%) lead fracture/extension wire failure in 2 (0.26%), IPG malfunction in 2 (0.26%), and hardware discomfort in 3 (0.4%) cases. In three patients, one lead was repositioned. In cases of infection, 87% of patients had either partial or complete removal of hardware. There was no mortality. The complications were analyzed for every 100 DBS procedures. There was a significant drop in the percentage of complications in from 23% in the first 100 cases to 7% in the last 100 cases (p < 0.0001). CONCLUSION Confusion remains the most frequent operative and perioperative complication. Erosion and infection of the surgical site represents the most frequent hardware complication. DBS surgery is safe and the complication rates are acceptably low. The complication rate also decreases with cumulative years of experience, demonstrating a learning curve effect.
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Affiliation(s)
- Paresh K Doshi
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India
| | - Neha Rai
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India
| | - Deepak Das
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India
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Kantzanou M, Korfias S, Panourias I, Sakas DE, Karalexi MA. Deep Brain Stimulation-Related Surgical Site Infections: A Systematic Review and Meta-Analysis. Neuromodulation 2021; 24:197-211. [PMID: 33462954 DOI: 10.1111/ner.13354] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/23/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Over the last decades, the increased use of deep brain stimulation (DBS) has raised concerns about the potential adverse health effects of the treatment. Surgical site infections (SSIs) following an elective surgery remain a major challenge for neurosurgeons. Few studies have examined the prevalence and risk factors of DBS-related complications, particularly focusing on SSIs. OBJECTIVES We systematically searched published literature, up to June 2020, with no language restrictions. MATERIALS AND METHODS Eligible were studies that examined the prevalence of DBS-related SSIs, as well as studies that examined risk and preventive factors in relation to SSIs. We extracted information on study characteristics, follow-up, exposure and outcome assessment, effect estimate and sample size. Summary odds ratios (sOR) and 95% confidence intervals (CI) were calculated from random-effects meta-analyses; heterogeneity and small-study effects were also assessed. RESULTS We identified 66 eligible studies that included 12,258 participants from 27 countries. The summary prevalence of SSIs was estimated at 5.0% (95% CI: 4.0%-6.0%) with higher rates for dystonia (6.5%), as well as for newer indications of DBS, such as epilepsy (9.5%), Tourette syndrome (5.9%) and OCD (4.5%). Similar prevalence rates were found between early-onset and late-onset hardware infections. Among risk and preventive factors, the perioperative implementation of intra-wound vancomycin was associated with statistically significantly lower risk of SSIs (sOR: 0.26, 95% CI: 0.09-0.74). Heterogeneity was nonsignificant in most meta-analyses. CONCLUSION The present study confirms the still high prevalence of SSIs, especially for newer indications of DBS and provides evidence that preventive measures, such as the implementation of topical vancomycin, seem promising in reducing the risk of DBS-related SSIs. Large clinical trials are needed to confirm the efficacy and safety of such measures.
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Affiliation(s)
- Maria Kantzanou
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Korfias
- Department of Neurosurgery, School of Medicine Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Panourias
- Department of Neurosurgery, Korgialenio and Mpenakio General Hospital of Athens, Red Cross, Athens, Greece
| | - Damianos E Sakas
- Department of Neurosurgery, School of Medicine Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria A Karalexi
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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14
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Long term mortality of patients with Parkinson's disease treated with deep brain stimulation in a reference center. Clin Neurol Neurosurg 2021; 202:106486. [PMID: 33493881 DOI: 10.1016/j.clineuro.2021.106486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 10/20/2020] [Accepted: 01/07/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is a common neurodegenerative disorder, with a higher risk of death than general population. Deep Brain Stimulation (DBS) has been used to treat PD for more than 2 decades, but few studies exist concerning mortality in this subset of patients. Our goal is to analyse mortality in PD patients treated with DBS in our centre. METHODS retrospective evaluation of clinical files of patients with PD who underwent DBS surgery consecutively between October 2002 and May 2019. RESULTS 346 patients were included in the analysis, 60 % male, with a mean age at disease onset of 48± 8 years (18-64), mean age at surgery of 60 ± 7 years (33-75), and mean disease duration until surgery of 14 ± 6 years (3-52). Mean follow-up after surgery was 7 ± 4 years (range 1-17). Overall mortality rate was 17.9 % and mean age at time of death was 71 ± 6 years. The main causes of death were pneumonia, dementia and acute myocardial infarction. In our series, male gender and disease duration until surgery were the only predictors of mortality in multivariate analysis. CONCLUSION Our study showed a long-term survival higher than previously described, and suggests that the treatment of patients with shorter disease evolution might have a survival benefit. The leading causes of death in PD patients treated with DBS seems unrelated to surgery, as the main causes of death are comparable to non-DBS patients.
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Mostofi A, Baig F, Bourlogiannis F, Uberti M, Morgante F, Pereira EAC. Postoperative Externalization of Deep Brain Stimulation Leads Does Not Increase Infection Risk. Neuromodulation 2020; 24:265-271. [PMID: 33301223 DOI: 10.1111/ner.13331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/25/2020] [Accepted: 11/17/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Externalization of deep brain stimulation (DBS) leads is performed to allow electrophysiological recording from implanted electrodes as well as assessment of clinical response to trial stimulation before implantable pulse generator (IPG) insertion. Hypothetically, lead externalization provides a route for inoculation and subsequent infection of hardware, though this has not been established definitively in the literature. We sought to determine if lead externalization affects the risk of infection in DBS surgery. MATERIALS AND METHODS We present our center's experience of lead externalization and surgical site infection (SSI) in DBS surgery for movement disorders. Patients were divided into two cohorts: one in which leads were not externalized and IPGs were implanted at the time of electrode insertion, and one in which leads were externalized for six days while patients underwent electrophysiological recording from DBS electrodes for research. We compare baseline characteristics of these two cohorts and their SSI rates. RESULTS Infective complications were experienced by 3/82 (3.7%) patients overall with one (1.2%) requiring complete hardware removal. These occurred in 1/36 (2.7%) in the externalized cohort and 2/46 (4.3%) in the nonexternalized cohort. The incidence of infection between the two cohorts was not significantly different (p = 1, two-tailed Fisher's exact test). This lack of significant difference persisted when baseline variation between the cohorts in age, hardware manufacturer, and indication for DBS were corrected by excluding patients implanted for dystonia, none of whom underwent externalization. We present and discuss in detail each of the three cases of infection. CONCLUSIONS Our data suggest that externalization of leads does not increase the risk of infective complications in DBS surgery. Lead externalization is a safe procedure which can provide a substrate for unique neurophysiological studies to advance knowledge and therapy of disorders treated with DBS.
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Affiliation(s)
- Abteen Mostofi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Department of Neurosurgery, Atkinson Morley Regional Neurosciences Centre, St George's Hospital, London, UK
| | - Fahd Baig
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Medical Research Council Brain Network Dynamics Unit, Oxford, UK
| | - Fotios Bourlogiannis
- Department of Neurosurgery, Atkinson Morley Regional Neurosciences Centre, St George's Hospital, London, UK
| | - Micaela Uberti
- Department of Neurosurgery, Atkinson Morley Regional Neurosciences Centre, St George's Hospital, London, UK
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Erlick A C Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Department of Neurosurgery, Atkinson Morley Regional Neurosciences Centre, St George's Hospital, London, UK
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16
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Abstract
Brain-machine interfaces (BMIs), which enable a two-way flow of signals, information, and directions between human neurons and computerized machines, offer spectacular opportunities for therapeutic and consumer applications, but they also present unique dangers to the safety, privacy, psychological health, and spiritual well-being of their users. The sale of these devices as commodities for profit exacerbates such issues and may subject the user to an unequal exchange with corporations. Catholic healthcare professionals and bioethicists should be especially concerned about the implications for the essential dignity of the persons using the new BMIs. Summary The commercial sale of brain-machine interfaces (BMIs) generates and exacerbates problems for end-users' safety, psychological health, and spiritual well-being.
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Obidin N, Tasnim F, Dagdeviren C. The Future of Neuroimplantable Devices: A Materials Science and Regulatory Perspective. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e1901482. [PMID: 31206827 DOI: 10.1002/adma.201901482] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/12/2019] [Indexed: 06/09/2023]
Abstract
The past two decades have seen unprecedented progress in the development of novel materials, form factors, and functionalities in neuroimplantable technologies, including electrocorticography (ECoG) systems, multielectrode arrays (MEAs), Stentrode, and deep brain probes. The key considerations for the development of such devices intended for acute implantation and chronic use, from the perspective of biocompatible hybrid materials incorporation, conformable device design, implantation procedures, and mechanical and biological risk factors, are highlighted. These topics are connected with the role that the U.S. Food and Drug Administration (FDA) plays in its regulation of neuroimplantable technologies based on the above parameters. Existing neuroimplantable devices and efforts to improve their materials and implantation protocols are first discussed in detail. The effects of device implantation with regards to biocompatibility and brain heterogeneity are then explored. Topics examined include brain-specific risk factors, such as bacterial infection, tissue scarring, inflammation, and vasculature damage, as well as efforts to manage these dangers through emerging hybrid, bioelectronic device architectures. The current challenges of gaining clinical approval by the FDA-in particular, with regards to biological, mechanical, and materials risk factors-are summarized. The available regulatory pathways to accelerate next-generation neuroimplantable devices to market are then discussed.
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Affiliation(s)
- Nikita Obidin
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Farita Tasnim
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Canan Dagdeviren
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
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18
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Hitti FL, Ramayya AG, McShane BJ, Yang AI, Vaughan KA, Baltuch GH. Long-term outcomes following deep brain stimulation for Parkinson's disease. J Neurosurg 2020; 132:205-210. [PMID: 30660117 DOI: 10.3171/2018.8.jns182081] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/28/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an effective treatment for several movement disorders, including Parkinson's disease (PD). While this treatment has been available for decades, studies on long-term patient outcomes have been limited. Here, the authors examined survival and long-term outcomes of PD patients treated with DBS. METHODS The authors conducted a retrospective analysis using medical records of their patients to identify the first 400 consecutive patients who underwent DBS implantation at their institution from 1999 to 2007. The medical record was used to obtain baseline demographics and neurological status. The authors performed survival analyses using Kaplan-Meier estimation and multivariate regression using Cox proportional hazards modeling. Telephone surveys were used to determine long-term outcomes. RESULTS Demographics for the cohort of patients with PD (n = 320) were as follows: mean age of 61 years, 70% male, 27% of patients had at least 1 medical comorbidity (coronary artery disease, congestive heart failure, diabetes mellitus, atrial fibrillation, or deep vein thrombosis). Kaplan-Meier survival analysis on a subset of patients with at least 10 years of follow-up (n = 200) revealed a survival probability of 51% (mean age at death 73 years). Using multivariate regression, the authors found that age at implantation (HR 1.02, p = 0.01) and male sex (HR 1.42, p = 0.02) were predictive of reduced survival. Number of medical comorbidities was not significantly associated with survival (p > 0.5). Telephone surveys were completed by 40 surviving patients (mean age 55.1 ± 6.4 years, 72.5% male, 95% subthalamic nucleus DBS, mean follow-up 13.0 ± 1.7 years). Tremor responded best to DBS (72.5% of patients improved), while other motor symptoms remained stable. Ability to conduct activities of daily living (ADLs) remained stable (dressing, 78% of patients; running errands, 52.5% of patients) or worsened (preparing meals, 50% of patients). Patient satisfaction, however, remained high (92.5% happy with DBS, 95% would recommend DBS, and 75% felt it provided symptom control). CONCLUSIONS DBS for PD is associated with a 10-year survival rate of 51%. Survey data suggest that while DBS does not halt disease progression in PD, it provides durable symptomatic relief and allows many individuals to maintain ADLs over long-term follow-up greater than 10 years. Furthermore, patient satisfaction with DBS remains high at long-term follow-up.
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Hamzaoğlu V, Özalp H, Doğu O, Öksüz N, Aydın S, Akbıyık T, Dağtekin A, Avcı E, Bağdatoğlu C. Management of hardware infections in deep-brain stimulation: A 4-year, single-center experience. NEUROL SCI NEUROPHYS 2020. [DOI: 10.4103/nsn.nsn_43_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Bullard AJ, Hutchison BC, Lee J, Chestek CA, Patil PG. Estimating Risk for Future Intracranial, Fully Implanted, Modular Neuroprosthetic Systems: A Systematic Review of Hardware Complications in Clinical Deep Brain Stimulation and Experimental Human Intracortical Arrays. Neuromodulation 2019; 23:411-426. [DOI: 10.1111/ner.13069] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 08/05/2019] [Accepted: 09/10/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Autumn J. Bullard
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
| | | | - Jiseon Lee
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
| | - Cynthia A. Chestek
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
- Department of Electrical Engineering and Computer Science University of Michigan Ann Arbor MI USA
| | - Parag G. Patil
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
- Department of Neurosurgery University of Michigan Medical School Ann Arbor MI USA
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21
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Hitti FL, Vaughan KA, Ramayya AG, McShane BJ, Baltuch GH. Reduced long-term cost and increased patient satisfaction with rechargeable implantable pulse generators for deep brain stimulation. J Neurosurg 2019; 131:799-806. [PMID: 30265199 DOI: 10.3171/2018.4.jns172995] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) has revolutionized the treatment of neurological disease, but its therapeutic efficacy is limited by the lifetime of the implantable pulse generator (IPG) batteries. At the end of the battery life, IPG replacement surgery is required. New IPGs with rechargeable batteries (RC-IPGs) have recently been introduced and allow for decreased reoperation rates for IPG replacements. The authors aimed to examine the merits and limitations of these devices. METHODS The authors reviewed the medical records of patients who underwent DBS implantation at their institution. RC-IPGs were placed either during initial DBS implantation or during an IPG change. A cost analysis was performed that compared RC-IPGs with standard IPGs, and telephone patient surveys were conducted to assess patient satisfaction. RESULTS The authors identified 206 consecutive patients from 2011 to 2016 who underwent RC-IPG placement (mean age 61 years; 67 women, 33%). Parkinson's disease was the most common indication for DBS (n = 144, 70%), followed by essential tremor (n = 41, 20%), dystonia (n = 13, 6%), depression (n = 5, 2%), multiple sclerosis tremor (n = 2, 1%), and epilepsy (n = 1, 0.5%). DBS leads were typically placed bilaterally (n = 192, 93%) and targeted the subthalamic nucleus (n = 136, 66%), ventral intermediate nucleus of the thalamus (n = 43, 21%), internal globus pallidus (n = 21, 10%), ventral striatum (n = 5, 2%), or anterior nucleus of the thalamus (n = 1, 0.5%). RC-IPGs were inserted at initial DBS implantation in 123 patients (60%), while 83 patients (40%) were converted to RC-IPGs during an IPG replacement surgery. The authors found that RC-IPG implantation resulted in $60,900 of cost savings over the course of 9 years. Furthermore, patient satisfaction was high with RC-IPG implantation. Overall, 87.3% of patients who responded to the survey were satisfied with their device, and only 6.7% found the rechargeable component difficult to use. In patients who were switched from a standard IPG to RC-IPG, the majority who responded (70.3%) preferred the rechargeable IPG. CONCLUSIONS RC-IPGs can provide DBS patients with long-term therapeutic benefit while minimizing the need for battery replacement surgery. The authors have implanted rechargeable stimulators in 206 patients undergoing DBS surgery, and here they demonstrate the cost-effectiveness and high patient satisfaction associated with this procedure.
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Tipper G, Ali Taqvi A, Singh A, Pohl U, Low H. The local thermal effect of using monopolar electrosurgery in the presence of a deep brain stimulator: Cadaveric studies on a lamb brain. J Clin Neurosci 2019; 65:134-139. [PMID: 30852074 DOI: 10.1016/j.jocn.2019.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/26/2019] [Accepted: 02/20/2019] [Indexed: 11/27/2022]
Abstract
In 2001, a patient with a deep brain stimulator (DBS) died following treatment with medical diathermy. Manufacturers have since advised against all forms of diathermy except bipolar electrosurgery in DBS patients. This effective ban on monopolar electrosurgery has an impact on the 150,000 patients treated with DBS to date, a number that is set to progressively increase. Analysis of the events, technical specifications, and literature suggests that the original ban was based on extrapolation from medical diathermy to electrosurgery, two very different treatment modalities. This prompted novel work exploring the impact of electrosurgery on DBS systems. Monopolar electrosurgery was employed on an animal cadaveric model with a DBS system paired with a thermocouple at the brain implant site. Prolonged use of monopolar, including at settings higher than normal surgical practice, resulted in a maximum mean temperature increase of only 2.6 °C. Microscopic post-event analysis showed no evidence of thermal injury at the implant site. The implication is that there may be limits within which monopolar electrosurgery use is safe in patients with DBS.
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Affiliation(s)
- Geoffrey Tipper
- Department of Neurosciences, Queens Hospital, Romford, Essex RM7 0AG, UK.
| | - Ahsan Ali Taqvi
- Department of Neurosciences, Queens Hospital, Romford, Essex RM7 0AG, UK
| | - Arvind Singh
- Department of Neurosciences, Queens Hospital, Romford, Essex RM7 0AG, UK
| | - Ute Pohl
- Department of Neurosciences, Queens Hospital, Romford, Essex RM7 0AG, UK
| | - HuLiang Low
- Department of Neurosciences, Queens Hospital, Romford, Essex RM7 0AG, UK
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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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Kim MS, Jeong JS, Ryu HS, Choi SH, Chung SJ. Infection related to deep brain stimulation in patients with Parkinson disease: Clinical characteristics and risk factors. J Neurol Sci 2017; 383:135-141. [PMID: 29246601 DOI: 10.1016/j.jns.2017.10.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/23/2017] [Accepted: 10/23/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Risk factors of infection after deep brain stimulation (DBS) surgery in patients with Parkinson disease (PD) have been controversial. We aimed to investigate the clinical characteristics and risk factors of infection after DBS surgery in PD patients. METHODS We retrospectively investigated 246 consecutive DBS surgeries in 169 advanced PD patients. Clinical data were collected and analyzed to clarify the clinical characteristics associated with infection after DBS surgery. Multivariate logistic regression analysis was used to assess risk factors for infection after DBS surgery. RESULTS Infection occurred in 5% of all DBS surgeries and in 7% of all PD patients who received DBS surgery. Most infections (75%) occurred within 3months after DBS surgery but it also occurred 21months after DBS surgery. Gram-positive bacteria were the most common pathogens (75%). Infection after DBS surgery was associated with short period of prophylactic antibiotic therapy (OR=0.62, 95% CI=0.45-0.85, P=0.002) and intensive care unit (ICU) management immediate after DBS surgery (OR=5.43, 95% CI=1.12-26.45, P=0.036). CONCLUSION Our study suggests that short period of prophylactic antibiotic therapy and ICU management after surgery may increase the risk of infection in PD patients who received DBS surgery.
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Affiliation(s)
- Mi Sun Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Sim Jeong
- Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Ho-Sung Ryu
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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