Systematic review of hardware-related complications of Deep Brain Stimulation: Do new indications pose an increased risk?

An unexpectedly high rate of revisions and removals in deep brain stimulation surgery: Analysis of multiple databases.

Since the senior author's (J.E.A.) first report in 1972 of the use of deep brain stimulation (DBS) to control chronic pain, electrodes for DBS have been implanted in 141 patients. Of reported series, this one has the largest number of patients and the longest period of follow-up. The mean age of patients in this study was 51.2 years. The mean length of follow-up was 80 months. Patients had experienced pain for a mean period of 65 months before DBS was attempted; all patients had exhausted other medical and surgical therapies. For the purposes of this study, pain states were characterized as being either nociceptive or deafferentation in nature. Nociceptive pain was treated primarily by stimulation of the periaqueductal or periventricular gray, and deafferentation pain was treated primarily by stimulation of the sensory thalamus. Eighty-four patients were treated for deafferentation pain, which included the thalamic pain syndrome (25 cases), peripheral neuropathic pain (16 cases), anesthesia dolorosa (12 cases), paraplegia pain (11 cases), postcordotomy dyesthesia (5 cases), phantom limb pain (5 cases), thoracic neuralgia (4 cases), and miscellaneous pain states (6 cases). We treated 57 patients with nociceptive pain states, 51 for low back and skeletal pain and 6 for pain from the invasion of cancer. Initial relief of pain was obtained by 83 patients (59%). After the mean follow-up period of 80 months, 42 patients (31%) continued to obtain significant pain relief with DBS. Some pain states, particularly anesthesia dolorosa and paraplegia pain, did not seem to respond to DBS. Major complications of therapy included wound infection (12%) and intracranial hemorrhage (3.5%); there was one death in the series (0.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of Chronic Pain by Deep Brain Stimulation: Long Term Follow-up and Review of the Literature

Proper selection of patients who will reliably benefit from deep brain stimulation (DBS) is critical to its success. This requires careful evaluation that should be delivered by an expert multidisciplinary team involving a movement disorder neurologist, a neurosurgeon, a neuropsychologist, and a psychiatrist. The most suitable candidates for DBS suffer from Parkinson's disease with motor fluctuations and/or dyskinesias that are not adequately controlled with optimized medical therapy, or with medication-refractory tremor. During the best on-motor periods, gait difficulties, instability, and speech problems should be minimal, reflecting an excellent response to levodopa in the ideal candidate. The cognitive, psychiatric, and behavioral status must be normal or minimally affected, with the exception of dopamine agonist drug-induced impulse control disorders, which are usually improved after successful surgery and drug withdrawal. Moreover, the patients have no serious comorbidities. Most patients corresponding to this profile suffer from a relatively young onset of Parkinson's disease, and are aged less than 70 years at the time of surgery. Indeed, most patients fall outside this ideal description, and the medical art is to appreciate for each patient the extent to which the alterations of these features can be accepted. Eventually, patients make their own decision from detailed information of their individualized risks and benefits of DBS. Patient expectations, cooperation, and familial support are also important considerations.

Deep brain stimulation for Parkinson’s disease – patient selection

Introduction
The Neurostimulation Appropriateness Consensus Committee (NACC) was formed by the International Neuromodulation Society (INS) in 2012 to evaluate the evidence to reduce the risk of complications and improve the efficacy of neurostimulation. The first series of papers, published in 2014, focused on the general principles of appropriate practice in the surgical implantation of neurostimulation devices. The NACC was reconvened in 2014 to address specific patient care issues, including bleeding and coagulation.

Methods
The INS strives to improve patient care in an evidence-based fashion. The NACC members were appointed or recruited by the INS leadership for diverse expertise, including international clinical expertise in many areas of neurostimulation, evidence evaluation, and publication. The group developed best practices based on peer-reviewed evidence and, in the absence of specific evidence, on expert opinion. Recommendations were based on international evidence in accordance with guideline creation.

Conclusions
The NACC has recommended specific measures to reduce the risk of bleeding and neurological injury secondary to impairment of coagulation in the setting of implantable neurostimulation devices in the spine, brain, and periphery.

The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations on Bleeding and Coagulation Management in Neurostimulation Devices.

Five-year follow-up of 23 asymmetrical Parkinson's disease patients treated with unilateral subthalamic nucleus stimulation

Objective To analyze the risk factors of intracranial hemorrhage in deep brain stimulation(DBS)and ablation procedures in a large series of patients with movement disorders in order to reduce the incidence of hemorrhage.Methads 689 patients treated with DBS and ablation procedures were enrolled in this study(DBS in 113 cases,ablation in 576 cases and DBS after prior unilateral ablation procedure in 11 cases).In 853 target procedures,DBS was employed in 195 targets(188 subthalamic nucleus targets,5 ventral intermediate targets and 2 internal globus pallidus targets),the ablation procedure was employed in 658 targets(478 intemal globus pallidus targets,180 ventral intermediate targets).Results There were 14 asymptomatic and 10 symptomatic intracranial hematomas.There wag a statistically significant relationship between the risk of symptomatic hematoma and hypertension.The incidence of hematoins in 2～4 microelectrode recording penetrations was6.9%.whereas 2.2%in 1 microelectrode recording penetration.There Wag only one agymptomatic hematoma in 195 DBS targets.Conclusion The humber of micreelectrode passes used to determine target location is correlated with the risk of hemorrhage.Ablation procedure carries a higher risk of hemorrhage than that of DBS.

Key words: 
Movement disorder; Deep brain stimulation; Pallidotomy; Thalamotomy; Intracerebral hemorrhage

Risks of intracranial hemorrhage in deep brain stimulation and ablation in patients With movement disorders

Objective: Although deep brain stimulation (DBS) is nonablative, it may give rise to many complications. In order to identify and reduce factors contributing to the complications, w

Avoidance and management of surgical and hardware-related complications of deep brain stimulation.

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Five-year follow-up of 23 asymmetrical Parkinson's disease patients treated with unilateral subthalamic nucleus stimulation

Risks of intracranial hemorrhage in deep brain stimulation and ablation in patients With movement disorders

Avoidance and management of surgical and hardware-related complications of deep brain stimulation.