Can Deep Brain Stimulation Withdrawal Syndromes Be Avoided by Removing Infected Implanted Pulse Generator and Cables with Contralateral Replacement in the Same Session?

Objective: Infections are feared complications following deep brain stimulation in 1.9 to 17.6% of cases. These infections can necessitate the removal of implants, which carries the risk of life-threatening withdrawal syndromes, especially in patients suffering from Parkinson’s disease. In this report, we describe our procedure of removing an infected implanted pulse generator (IPG) and cables with contralateral replacement in the same session. Methods: We retrospectively analysed all patients with transpositions of an IPG and cables between 2017 and 2020 in a single-centre, university hospital setting. Medical records of all patients undergoing this particular surgical procedure were systematically reviewed. The shortest follow-up time was 12 months. Results: Between 2017 and 2020, we had 6 patients with a high risk of withdrawal syndrome in whom an infected IPG with cables was removed and replaced on the opposite side in the same session. There were postoperative complications in 2 patients: in one, the generator had to be re-affixed, and in the second, a skin transplant was required over one electrode because of skin necrosis. No case of invasive infection was seen, and the stimulation therapy was not interrupted. Conclusion: One-session removal of an IPG and cables with contralateral replacement seems to be an effective therapy for patients at high risk of withdrawal syndrome.

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Reoperation for device infection and erosion following deep brain stimulation implantable pulse generator placement

Journal of Neurosurgery ◽

10.3171/2019.3.jns183023 ◽

2020 ◽

Vol 133 (2) ◽

pp. 403-410 ◽

Cited By ~ 1

Author(s):

Travis J. Atchley ◽

Nicholas M. B. Laskay ◽

Brandon A. Sherrod ◽

A. K. M. Fazlur Rahman ◽

Harrison C. Walker ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Movement Disorders ◽

Pulse Generator ◽

Rank Test ◽

Implantable Pulse Generator ◽

Device Infection ◽

Deep Brain

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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Deep brain stimulation lead-contact heating during 3T MRI: single- versus dual-channel pulse generator configurations

International Journal of Neuroscience ◽

10.3109/00207454.2013.840303 ◽

2013 ◽

Vol 124 (3) ◽

pp. 166-174 ◽

Cited By ~ 5

Author(s):

Jules M. Nazzaro ◽

Joshua A. Klemp ◽

William M. Brooks ◽

Galen Cook-Wiens ◽

Matthew S. Mayo ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Pulse Generator ◽

3T Mri ◽

Dual Channel ◽

Contact Heating ◽

Single Versus ◽

Deep Brain

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Design of a Small Modified Minkowski Fractal Antenna for Passive Deep Brain Stimulation Implants

International Journal of Antennas and Propagation ◽

10.1155/2014/749043 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Sara Manafi ◽

Hai Deng

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Performance Metrics ◽

Pulse Generator ◽

Fractal Antenna ◽

Dual Frequency ◽

Frequency Bands ◽

Received Power ◽

Minkowski Fractal ◽

Deep Brain

A small planar modified Minkowski fractal antenna is designed and simulated in dual frequency bands (2.4 and 5.8 GHz) for wireless energy harvesting by deep brain stimulation (DBS) devices. The designed antenna, physically being confined inside a miniaturized structure, can efficiently convert the wireless signals in dual ISM frequency bands to the energy source to recharge the DBS battery or power the pulse generator directly. The performance metrics such as the return loss, the specific absorption rate (SAR), and the radiation pattern within skin and muscle-fat-skin tissues are evaluated for the designed antenna. The gain of the proposed antenna is 3.2 dBi at 2.4 GHz and 4.7 dBi at 5.8 GHz; also the averaged SAR of the antenna in human body tissue is found to be well below the legally allowed limit at both frequency bands. The link budget shows the received power at the distance of 25 cm at 2.4 GHz and 5.8 GHz are around 0.4 mW and 0.04 mW, which can empower the DBS implant. The large operational bandwidth, the physical compactness, and the efficiency in wireless signal reception make this antenna suitable in being used in implanted biomedical devices such as DBS pulse generators.

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Delayed dopamine agonist withdrawal syndrome after deep brain stimulation for Parkinson disease

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000762 ◽

2019 ◽

pp. 10.1212/CPJ.0000000000000762

Author(s):

Eric M. Jackowiak ◽

Kelvin L. Chou ◽

Parag G. Patil ◽

Emily Levin ◽

Daniel Leventhal

Keyword(s):

Deep Brain Stimulation ◽

Parkinson Disease ◽

Dopamine Agonist ◽

Brain Stimulation ◽

Withdrawal Syndrome ◽

Deep Brain

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Deep brain stimulator implantation in a diagnostic MRI suite: infection history over a 10-year period

Journal of Neurosurgery ◽

10.3171/2015.7.jns15750 ◽

2017 ◽

Vol 126 (1) ◽

pp. 108-113 ◽

Cited By ~ 13

Author(s):

Alastair J. Martin ◽

Paul S. Larson ◽

Nathan Ziman ◽

Nadja Levesque ◽

Monica Volz ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Operating Room ◽

Infection Rate ◽

Brain Stimulation ◽

Pulse Generator ◽

Surgical Site Infections ◽

Air Filtration ◽

Staphylococcus Epidermis ◽

Mri Guided ◽

Deep Brain

OBJECTIVE The objective of this study was to assess the incidence of postoperative hardware infection following interventional (i)MRI–guided implantation of deep brain stimulation (DBS) electrodes in a diagnostic MRI scanner. METHODS A diagnostic 1.5-T MRI scanner was used over a 10-year period to implant DBS electrodes for movement disorders. The MRI suite did not meet operating room standards with respect to airflow and air filtration but was prepared and used with conventional sterile procedures by an experienced surgical team. Deep brain stimulation leads were implanted while the patient was in the magnet, and patients returned 1–3 weeks later to undergo placement of the implantable pulse generator (IPG) and extender wire in a conventional operating room. Surgical site infections requiring the removal of part or all of the DBS system within 6 months of implantation were scored as postoperative hardware infections in a prospective database. RESULTS During the 10-year study period, the authors performed 164 iMRI-guided surgical procedures in which 272 electrodes were implanted. Patients ranged in age from 7 to 78 years, and an overall infection rate of 3.6% was found. Bacterial cultures indicated Staphylococcus epidermis (3 cases), methicillin-susceptible Staphylococcus aureus (2 cases), or Propionibacterium sp. (1 case). A change in sterile practice occurred after the first 10 patients, leading to a reduction in the infection rate to 2.6% (4 cases in 154 procedures) over the remainder of the procedures. Of the 4 infections in this patient subset, all occurred at the IPG site. CONCLUSIONS Interventional MRI–guided DBS implantation can be performed in a diagnostic MRI suite with an infection risk comparable to that reported for traditional surgical placement techniques provided that sterile procedures, similar to those used in a regular operating room, are practiced.

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Deep brain stimulation: custom-made silicone-coated pulse-generator implantation after allergic reaction to generator compounds

Acta Neurochirurgica ◽

10.1007/s00701-017-3373-z ◽

2017 ◽

Vol 160 (2) ◽

pp. 385-387

Author(s):

Judith Anthofer ◽

Andreas Herbst ◽

Annettte Janzen ◽

Max Lange ◽

Alexander Brawanski ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Allergic Reaction ◽

Brain Stimulation ◽

Pulse Generator ◽

Custom Made ◽

Deep Brain

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Recharging Difficulty With Pulse Generator After Deep Brain Stimulation: A Case Series of Five Patients

Frontiers in Neuroscience ◽

10.3389/fnins.2021.705483 ◽

2021 ◽

Vol 15 ◽

Author(s):

Hongyang Li ◽

Daoqing Su ◽

Yijie Lai ◽

Xinmeng Xu ◽

Chencheng Zhang ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Pulse Generator ◽

Rare Complication ◽

Subcutaneous Fat ◽

Treatment Strategies ◽

Case Series ◽

Initial Surgery ◽

Rechargeable Cell ◽

Deep Brain

Background: Deep brain stimulation (DBS) is a well-established treatment for a variety of movement disorders. Rechargeable cell technology was introduced to pulse generator more than 10 years ago and brought great benefits to patients. However, with the widespread use of rechargeable implanted pulse generators (r-IPGs), a new hardware complication, when charging the r-IPG has been difficult, was encountered.Objective: The aims of this study were to report five cases confronted with r-IPG charging difficulty postoperatively and to explore the predisposing factors and treatment strategies for this rare complication.Methods: We retrospectively reviewed our DBS patient database for those who were implanted with r-IPGs. From 2012, we identified a total of 1,226 patients, with five of them experiencing charging difficulties after surgery. Detailed patient profiles and clinical procedures were scrutinized and reviewed.Results: All the charging problems were resolved by reoperation. Cases 1 and 2 required their r-IPGs to be anchored to the muscle and fascia. Cases 3 and 4 had their r-IPGs inserted in the wrong orientation at the initial surgery, which was resolved by turning around the r-IPGs at the revision surgery. Case 5, in which we propose that the thick subcutaneous fat layer blocked the connection between the r-IPG and the recharger, required a second operation to reposition the r-IPG in a shallow layer underneath the skin. For all cases, the charging problems were resolved without reoccurrences to date.Conclusion: Our case series indicates a novel hardware complication of DBS surgery, which had been rarely reported before. In this preliminary study, we describe several underlying causes of this complication and treatment methods.

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Deep stimulation in neurosurgery

Clinical Practice ◽

10.17816/clinpract10163-71 ◽

2019 ◽

Vol 10 (1) ◽

pp. 63-71

Author(s):

Aleksandr A. Kalinkin ◽

Alexey G. Vinokurov ◽

Olga N. Kalinkina ◽

Alexander S. Ilinykh ◽

Andrey A. Bocharov ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Deep Brain Stimulation ◽

High Risk ◽

Brain Stimulation ◽

Conservative Therapy ◽

The Central Nervous System ◽

The Brain ◽

Deep Brain ◽

Stimulation Of

The technique of deep brain stimulation is used to treat patients with various diseases of the central nervous system who are not amenable to conservative therapy, while open interventions in them are associated with a high risk of complications. In the review, we evaluate the efficiency of the deep stimulation of different regions of the brain in some pharmacoresistant forms of diseases.

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Deep Brain Stimulation/Stereotaxic Surgery

10.1093/med/9780190850036.003.0019 ◽

2018 ◽

Author(s):

Sandra Machado

Keyword(s):

Deep Brain Stimulation ◽

Postoperative Complications ◽

Essential Tremor ◽

Brain Stimulation ◽

Movement Disorders ◽

Pulse Generator ◽

Stereotactic Implantation ◽

Two Stages ◽

Effective Use ◽

Deep Brain

Deep brain stimulation (DBS) is now a widely accepted treatment option for patients with movement disorders such as parkinsonism and essential tremor. DBS surgery presents challenges to the anesthesiologist as often these patients are required to be awake for accurate placement of the stimulators. Additionally, patients with movement disorders often have comorbidities that increase their risk of perioperative and postoperative complications. DBS surgery is often divided into two stages (1) stereotactic implantation of the DBS leads and (2) internalization of the pulse generator, with each of these stages stage having distinct anesthesia demands. Ongoing studies are exploring other indications for the effective use of DBS surgery.

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