Introduction: Currently, sub-second monitoring of neurotransmitter release in humans can only be performed during standard of care invasive procedures like DBS electrode implantation. The procedure requires acute insertion of a research probe and additional time in surgery, which may increase infection risk. We sought to determine the impact of our research procedure, particularly the extended time in surgery, on infection risk.
Methods: We screened 607 DBS electrode implantation procedures performed at Wake Forest Baptist Medical Center between January 2011 through October 2020 using International Classification of Diseases (ICD) codes for infection. During this period, 116 cases included an IRB approved 30-minute research protocol, during the DBS electrode implantation surgery, to monitor sub-second neurotransmitter release. We used Fisher's Exact test (FET) to determine if there was a significant change in the infection rate following DBS electrode implantation procedures that included, versus those that did not include, the neurotransmitter monitoring research protocol.
Results: Within 30-days following DBS electrode implantation, infection was observed in 7 (1.43%) out of 491 procedures that did not include the research procedure and 2 (1.72%) of the 116 procedures that did include the research procedure. Total infection rates (i.e., not constrained by 30-day time window) for all non-research cases was 28/491 (5.70%) and only 4/116 (3.45%) for research inclusive cases. Notably, all types of infection observed were typical of those expected for DBS electrode implantation.
Conclusion: Total infection rates are not statistically different in patients who performed the research procedure (3.45% vs. 5.70%; p = 0.4872, FET) and not statistically different across research and non-research groups within 30-days following the research procedure (1.72% vs. 1.43%; p = 0.684, FET). Our results demonstrate that the research procedures used for sub-second monitoring of neurotransmitter release in humans can be performed without increasing the rate of infection.
A spatiotemporal analysis of gait freezing and the impact of pedunculopontine nucleus stimulation
