Surgical placement of deep brain stimulation leads for the treatment of movement disorders: intraoperative aspects: Physiological mapping, test stimulation, and patient evaluation

OBJECTIVEInfection and erosion following implantable pulse generator (IPG) placement are associated with morbidity and cost for patients with deep brain stimulation (DBS) systems. Here, the authors provide a detailed characterization of infection and erosion events in a large cohort that underwent DBS surgery for movement disorders.METHODSThe authors retrospectively reviewed consecutive IPG placements and replacements in patients who had undergone DBS surgery for movement disorders at the University of Alabama at Birmingham between 2013 and 2016. IPG procedures occurring before 2013 in these patients were also captured. Descriptive statistics, survival analyses, and logistic regression were performed using generalized linear mixed effects models to examine risk factors for the primary outcomes of interest: infection within 1 year or erosion within 2 years of IPG placement.RESULTSIn the study period, 384 patients underwent a total of 995 IPG procedures (46.4% were initial placements) and had a median follow-up of 2.9 years. Reoperation for infection occurred after 27 procedures (2.7%) in 21 patients (5.5%). No difference in the infection rate was observed for initial placement versus replacement (p = 0.838). Reoperation for erosion occurred after 16 procedures (1.6%) in 15 patients (3.9%). Median time to reoperation for infection and erosion was 51 days (IQR 24–129 days) and 149 days (IQR 112–285 days), respectively. Four patients with infection (19.0%) developed a second infection requiring a same-side reoperation, two of whom developed a third infection. Intraoperative vancomycin powder was used in 158 cases (15.9%) and did not decrease the infection risk (infected: 3.2% with vancomycin vs 2.6% without, p = 0.922, log-rank test). On logistic regression, a previous infection increased the risk for infection (OR 35.0, 95% CI 7.9–156.2, p < 0.0001) and a lower patient BMI was a risk factor for erosion (BMI ≤ 24 kg/m2: OR 3.1, 95% CI 1.1–8.6, p = 0.03).CONCLUSIONSIPG-related infection and erosion following DBS surgery are uncommon but clinically significant events. Their respective timelines and risk factors suggest different etiologies and thus different potential corrective procedures.

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Moving Forward: Advances in the Treatment of Movement Disorders with Deep Brain Stimulation

Frontiers in Integrative Neuroscience ◽

10.3389/fnint.2011.00069 ◽

2011 ◽

Vol 5 ◽

Cited By ~ 18

Author(s):

Terry K. Schiefer ◽

Joseph Y. Matsumoto ◽

Kendall H. Lee

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Movement Disorders ◽

Deep Brain

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Basal ganglia local field potentials: applications in the development of new deep brain stimulation devices for movement disorders

Expert Review of Medical Devices ◽

10.1586/17434440.4.5.605 ◽

2007 ◽

Vol 4 (5) ◽

pp. 605-614 ◽

Cited By ~ 46

Author(s):

Sara Marceglia ◽

Lorenzo Rossi ◽

Guglielmo Foffani ◽

AnnaMaria Bianchi ◽

Sergio Cerutti ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Basal Ganglia ◽

Local Field ◽

Brain Stimulation ◽

Movement Disorders ◽

Local Field Potentials ◽

Field Potentials ◽

Deep Brain

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Deep Brain Stimulation for Non-Movement Disorders

Contemporary Neurosurgery ◽

10.1097/01.cne.0000336901.26339.43 ◽

2008 ◽

Vol 30 (19) ◽

pp. 1-5

Author(s):

Andrew C. Zacest ◽

Kim J. Burchiel

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Movement Disorders ◽

Deep Brain

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Evaluation of Deep Brain Stimulation Effect on Motor Signs of Individuals with Movement Disorders Through Gaussian Models

2021 10th International IEEE/EMBS Conference on Neural Engineering (NER) ◽

10.1109/ner49283.2021.9441173 ◽

2021 ◽

Author(s):

Ariana Moura Cabral ◽

Bruno Lima Pessoa ◽

Gabriel Pereira Escudeiro ◽

Igor Duque G. Silva ◽

Marcus Fraga Vieira ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Movement Disorders ◽

Gaussian Models ◽

Deep Brain

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218 Target Selection for Deep Brain Stimulation in Children with Secondary Dystonia Utilizing Temporary Depth Electrodes for Stimulation and Chronic Recording

Neurosurgery ◽

10.1093/neuros/nyx417.218 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 259-259

Author(s):

Richard Aaron Robison ◽

Diana Ferman ◽

Mark A Liker ◽

Terrence Sanger

Keyword(s):

Deep Brain Stimulation ◽

Beneficial Effect ◽

Brain Stimulation ◽

Single Unit ◽

Response To Therapy ◽

Rapid Improvement ◽

Secondary Dystonia ◽

Test Stimulation ◽

Depth Electrodes ◽

Deep Brain

Abstract INTRODUCTION The optimal target for deep brain stimulation (DBS) treatment in children with secondary dystonia is not known, and the target may vary depending on the etiology and anatomic distribution of injury in each child. We present a new technique for determining optimal neuro-anatomical targets in these patients. METHODS Up to ten depth electrodes are implanted in each child in multiple brain regions, including bilateral STN, GPi, and the VLa (Vo), VLp (Vim) and VPL nuclei of the thalamus. Each electrode had both high-impedance micro contacts to identify single unit firing and macro contacts for identifying local field potentials and for performing test stimulation. Children were monitored for up to one week with continuous recording from all electrodes and intermittent test stimulation at bilateral contact pairs. RESULTS >No single consistent pattern of abnormality was found. Most often, single-unit recording showed high firing rates in GPi, and dystonic movement correlated with activity VLa or VLp. The optimal stimulation target varied between children, with rapid improvement of dystonic postures during stimulation in either VLa, VLp or VPL. Stimulation of STN caused resolution of spasms during sleep in one child. Stimulation in GPi did not produce an immediate effect during the recording period, consistent with known latency of treatment effect. All of the children were implanted with up to 4 permanent stimulation leads connected to implanted pulse generators. Preliminary clinical observations show significant beneficial effect in all children. CONCLUSION This new method of DBS targeting identified targets that varied between children. Early response to therapy suggests a beneficial effect that exceeds what would be expected for GPi stimulation alone. This technique may increase the effectiveness of DBS in secondary dystonia and may allow application to a broader range of conditions in children not previously known to respond to stimulation.

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Pediatric Deep Brain Stimulation Using Awake Recording and Stimulation for Target Selection in an Inpatient Neuromodulation Monitoring Unit

Brain Sciences ◽

10.3390/brainsci8070135 ◽

2018 ◽

Vol 8 (7) ◽

pp. 135 ◽

Cited By ~ 9

Author(s):

Terence D. Sanger ◽

Mark Liker ◽

Enrique Arguelles ◽

Ruta Deshpande ◽

Arash Maskooki ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Basal Ganglia ◽

Brain Stimulation ◽

Rating Scale ◽

Target Selection ◽

Test Stimulation ◽

Depth Electrodes ◽

A New Technique ◽

High Degree ◽

Deep Brain

Deep brain stimulation (DBS) for secondary (acquired, combined) dystonia does not reach the high degree of efficacy achieved in primary (genetic, isolated) dystonia. We hypothesize that this may be due to variability in the underlying injury, so that different children may require placement of electrodes in different regions of basal ganglia and thalamus. We describe a new targeting procedure in which temporary depth electrodes are placed at multiple possible targets in basal ganglia and thalamus, and probing for efficacy is performed using test stimulation and recording while children remain for one week in an inpatient Neuromodulation Monitoring Unit (NMU). Nine Children with severe secondary dystonia underwent the NMU targeting procedure. In all cases, 4 electrodes were implanted. We compared the results to 6 children who had previously had 4 electrodes implanted using standard intraoperative microelectrode targeting techniques. Results showed a significant benefit, with 80% of children with NMU targeting achieving greater than 5-point improvement on the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), compared with 50% of children using intraoperative targeting. NMU targeting improved BFMDRS by an average of 17.1 whereas intraoperative targeting improved by an average of 10.3. These preliminary results support the use of test stimulation and recording in a Neuromodulation Monitoring Unit (NMU) as a new technique with the potential to improve outcomes following DBS in children with secondary (acquired) dystonia. A larger sample size will be needed to confirm these results.

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