Comprehensive analysis of risk factors for seizures after deep brain stimulation surgery

Object The aim of this study was to assess risk factors for postoperative seizures after deep brain stimulation (DBS) lead implantation surgery and the impact of such seizures on length of stay and discharge disposition. Methods The authors reviewed a consecutive series of 161 cases involving patients who underwent implantation of 288 electrodes for treatment of movement disorders at a single institution to determine the absolute risk of postoperative seizures, to describe the timing and type of seizures, to identify statistically significant risk factors for seizures, and to determine whether there are possible indications for seizure prophylaxis after DBS lead implantation. The electronic medical records were reviewed to identify demographic details, medical history, operative course, and postoperative outcomes and complications. To evaluate significant associations between potential risk factors and postoperative seizures, both univariate and multivariate analyses were performed. Results Seven (4.3%) of 161 patients experienced postoperative seizures, all of which were documented to have been generalized tonic-clonic seizures. In 5 (71%) of 7 cases, patients only experienced a single seizure. Similarly, in 5 of 7 cases, patients experienced seizures within 24 hours of surgery. In 6 (86%) of the 7 cases, seizures occurred within 48 hours of surgery. Univariate analysis identified 3 significant associations (or risk factors) for postoperative seizures: abnormal findings on postoperative imaging (hemorrhage, edema, and or ischemia; p < 0.001), age greater than 60 years (p = 0.021), and transventricular electrode trajectories (p = 0.023). The only significant factor identified on multivariate analysis was abnormal findings on postoperative imaging (p < 0.0001, OR 50.4, 95% CI 5.7–444.3). Patients who experienced postoperative seizures had a significantly longer length of stay than those who were seizure free (mean ± SD 5.29 ± 3.77 days vs 2.38 ± 2.38 days; p = 0.002, Student 2-tailed t-test). Likewise, final discharge to home was significantly less likely in patients who experienced seizures after implantation (43%) compared with those patients who did not (92%; p = 0.00194, Fisher exact test). Conclusions These results affirm that seizures are an uncommon complication of DBS surgery and generally occur within 48 hours of surgery. The results also indicate that hemorrhage, edema, or ischemia on postoperative images (“abnormal” imaging findings) increases the relative risk of postoperative seizures by 30- to 50-fold, providing statistical credence to the long-held assumption that seizures are associated with intracranial vascular events. Even in the setting of a postimplantation imaging abnormality, long-term anticonvulsant therapy will not likely be required because none of our patients developed chronic epilepsy.

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Deep brain stimulation hardware–related infections: 10-year experience at a single institution

Journal of Neurosurgery ◽

10.3171/2017.9.jns1780 ◽

2019 ◽

Vol 130 (2) ◽

pp. 629-638 ◽

Cited By ~ 4

Author(s):

Kingsley O. Abode-Iyamah ◽

Hsiu-Yin Chiang ◽

Royce W. Woodroffe ◽

Brian Park ◽

Francis J. Jareczek ◽

...

Keyword(s):

Risk Factors ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Single Institution ◽

Chi Square ◽

Related Factors ◽

Exact Test ◽

Vancomycin Powder ◽

The Impact ◽

Deep Brain

OBJECTIVEDeep brain stimulation is an effective surgical treatment for managing some neurological and psychiatric disorders. Infection related to the deep brain stimulator (DBS) hardware causes significant morbidity: hardware explantation may be required; initial disease symptoms such as tremor, rigidity, and bradykinesia may recur; and the medication requirements for adequate disease management may increase. These morbidities are of particular concern given that published DBS-related infection rates have been as high as 23%. To date, however, the key risk factors for and the potential preventive measures against these infections remain largely uncharacterized. In this study, the authors endeavored to identify possible risk factors for DBS-related infection and analyze the efficacy of prophylactic intrawound vancomycin powder (VP).METHODSThe authors performed a retrospective cohort study of patients who had undergone primary DBS implantation at a single institution in the period from December 2005 through September 2015 to identify possible risk factors for surgical site infection (SSI) and to assess the impact of perioperative (before, during, and after surgery) prophylactic antibiotics on the SSI rate. They also evaluated the effect of a change in the National Healthcare Safety Network’s definition of SSI on the number of infections detected. Statistical analyses were performed using the 2-sample t-test, the Wilcoxon rank-sum test, the chi-square test, Fisher’s exact test, or logistic regression, as appropriate for the variables examined.RESULTSFour hundred sixty-four electrodes were placed in 242 adults during 245 primary procedures over approximately 10.5 years; most patients underwent bilateral electrode implantation. Among the 245 procedures, 9 SSIs (3.7%) occurred within 90 days and 16 (6.5%) occurred within 1 year of DBS placement. Gram-positive bacteria were the most common etiological agents. Most patient- and procedure-related characteristics did not differ between those who had acquired an SSI and those who had not. The rate of SSIs among patients who had received intrawound VP was only 3.3% compared with 9.7% among those who had not received topical VP (OR 0.32, 95% CI 0.10–1.02, p = 0.04). After controlling for patient sex, the association between VP and decreased SSI risk did not reach the predetermined level of significance (adjusted OR 0.32, 95% CI 0.10–1.03, p = 0.06). The SSI rates were similar after staged and unstaged implantations.CONCLUSIONSWhile most patient-related and procedure-related factors assessed in this study were not associated with the risk for an SSI, the data did suggest that intrawound VP may help to reduce the SSI risk after DBS implantation. Furthermore, given the implications of SSI after DBS surgery and the frequency of infections occurring more than 90 days after implantation, continued follow-up for at least 1 year after such a procedure is prudent to establish the true burden of these infections and to properly treat them when they do occur.

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Deep Brain Stimulation Complications in Patients With Parkinson’s Disease and Surgical Modifications: A Single-Center Retrospective Analysis

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2021.684895 ◽

2021 ◽

Vol 15 ◽

Author(s):

Shuo Xu ◽

Wenfei Wang ◽

Si Chen ◽

Qianqian Wu ◽

Chao Li ◽

...

Keyword(s):

Risk Factors ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Early Stage ◽

Univariate Analysis ◽

Unplanned Readmission ◽

Consecutive Series ◽

Deep Brain

BackgroundAs a complication-prone operation, deep brain stimulation (DBS) has become the first-line surgical approach for patients with advanced Parkinson’s disease (PD). This study aimed to evaluate the incidence and risk factors of DBS-associated complications.MethodsWe have reviewed a consecutive series of patients with PD undergoing DBS procedures to describe the type, severity, management, and outcome of postoperative complications from January 2011 to December 2018. Both univariate and multivariate analyses were performed to identify statistically significant risk factors. We also described our surgical strategies to minimize the adverse events.ResultsA total of 225 patients underwent 229 DBS implantation procedures (440 electrodes), of whom 20 patients experienced 23 DBS-associated complications, including ten operation-related complications and 13 hardware-related ones. Univariate analysis elucidated that comorbid medical conditions (P = 0.024), hypertension (P = 0.003), early-stage operation (P < 0.001), and unilateral electrode implantation (P = 0.029) as risk factors for overall complications, or more specifically, operation-related complications demonstrated in the stratified analysis. In contrast, no risk factor for hardware-related complications was identified. Statistical significances of hypertension (OR = 3.33, 95% CI: 1.14–9.71, P = 0.027) and early-stage (OR = 11.04, 95% CI: 2.42–50.45, P = 0.002) were further validated via multivariate analysis. As the annual number of DBS procedures increased, the incidence of complications gradually decreased (R = −0.699, P < 0.01). Additionally, there was a strong correlation between surgical complications and unplanned readmission (R = 0.730, P < 0.01).ConclusionThe importance of cumulative experience and relevant technique modifications should be addressed to prevent DBS-associated complications and unplanned readmission.

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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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Pallidal Deep Brain Stimulation for Primary Dystonia in Children

Neurosurgery ◽

10.1227/neu.0b013e3182077396 ◽

2011 ◽

Vol 68 (3) ◽

pp. 738-743 ◽

Cited By ~ 51

Author(s):

Abilash Haridas ◽

Michele Tagliati ◽

Irene Osborn ◽

Ioannis Isaias ◽

Yakov Gologorsky ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Clinical Improvement ◽

Brain Stimulation ◽

Functional Disability ◽

Rating Scale ◽

Retrospective Chart Review ◽

Consecutive Series ◽

Internal Globus Pallidus ◽

Deep Brain

Abstract BACKGROUND: Deep brain stimulation (DBS) at the internal globus pallidus (GPi) has replaced ablative procedures for the treatment of primary generalized dystonia (PGD) because it is adjustable, reversible, and yields robust clinical improvement that appears to be long lasting. OBJECTIVE: To describe the long-term responses to pallidal DBS of a consecutive series of 22 pediatric patients with PGD. METHODS: Retrospective chart review of 22 consecutive PGD patients, ≤21 years of age treated by one DBS team over an 8-year period. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to evaluate symptom severity and functional disability, pre- and post-operatively. Adverse events and medication changes were also noted. RESULTS: The median follow-up was 2 years (range, 1-8 years). All 22 patients reached 1-year follow-up; 14 reached 2 years, and 11 reached 3 years. The BFMDRS motor subscores were improved 84%, 93%, and 94% (median) at these time points. These motor responses were matched by equivalent improvements in function, and the response to DBS resulted in significant reductions in oral and intrathecal medication requirements after 12 and 24 months of stimulation. There were no hemorrhages or neurological complications related to surgery and no adverse effects from stimulation. Significant hardware-related complications were noted, in particular, infection (14%), which delayed clinical improvement. CONCLUSION: Pallidal DBS is a safe and effective treatment for PGD in patients <21 years of age. The improvement appears durable. Improvement in device design should reduce hardware-related complications over time.

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The risk factors of intracerebral hemorrhage in deep brain stimulation: does target matter?

Acta Neurochirurgica ◽

10.1007/s00701-021-04977-y ◽

2022 ◽

Author(s):

Hong Kyung Shin ◽

Mi Sun Kim ◽

Hyung Ho Yoon ◽

Sun Ju Chung ◽

Sang Ryong Jeon

Keyword(s):

Risk Factors ◽

Deep Brain Stimulation ◽

Intracerebral Hemorrhage ◽

Brain Stimulation ◽

Deep Brain

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Effects of deep brain stimulation on sleep-wake disturbances in patients with Parkinson's disease: A narrative review

Current Neuropharmacology ◽

10.2174/1570159x19666210215115718 ◽

2021 ◽

Vol 19 ◽

Author(s):

Yu Jin Jung ◽

Han-Joon Kim ◽

Sun Ha Paek ◽

Beomseok Jeon

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Early Stage ◽

Motor Symptoms ◽

Specific Effects ◽

The Impact ◽

Non Motor Symptoms ◽

Deep Brain

: Sleep-wake disturbances (SWD) are one of the most common non-motor symptoms in Parkinson's disease (PD) and can appear in the early stage even before the onset of motor symptoms. Deep brain stimulation (DBS) is an established treatment for the motor symptoms in patients with advanced PD. However, the effect of DBS on SWD and its specific mechanisms are not widely understood and remain controversial. In addition to the circuit-mediated direct effect, DBS may improve SWD by an indirect effect such as the resolution of nocturnal motor complications and a reduction of dopaminergic medication. Here, the authors review the recent literatures regarding the impact of DBS on SWD in patients with PD. Furthermore, the selection of the DBS targets and the specific effects of applying DBS to each target on SWD in PD are also discussed.

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Avoiding the ventricle: a simple step to improve accuracy of anatomical targeting during deep brain stimulation

Journal of Neurosurgery ◽

10.3171/2008.12.jns08885 ◽

2009 ◽

Vol 110 (6) ◽

pp. 1283-1290 ◽

Cited By ~ 52

Author(s):

Ludvic Zrinzo ◽

Arjen L. J. van Hulzen ◽

Alessandra A. Gorgulho ◽

Patricia Limousin ◽

Michiel J. Staal ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Electrode Placement ◽

Neurosurgical Procedures ◽

Electrode Implantation ◽

Clinical Observations ◽

Simple Step ◽

The Mean ◽

The Impact ◽

Deep Brain

Object The authors examined the accuracy of anatomical targeting during electrode implantation for deep brain stimulation in functional neurosurgical procedures. Special attention was focused on the impact that ventricular involvement of the electrode trajectory had on targeting accuracy. Methods The targeting error during electrode placement was assessed in 162 electrodes implanted in 109 patients at 2 centers. The targeting error was calculated as the shortest distance from the intended stereotactic coordinates to the final electrode trajectory as defined on postoperative stereotactic imaging. The trajectory of these electrodes in relation to the lateral ventricles was also analyzed on postoperative images. Results The trajectory of 68 electrodes involved the ventricle. The targeting error for all electrodes was calculated: the mean ± SD and the 95% CI of the mean was 1.5 ± 1.0 and 0.1 mm, respectively. The same calculations for targeting error for electrode trajectories that did not involve the ventricle were 1.2 ± 0.7 and 0.1 mm. A significantly larger targeting error was seen in trajectories that involved the ventricle (1.9 ± 1.1 and 0.3 mm; p < 0.001). Thirty electrodes (19%) required multiple passes before final electrode implantation on the basis of physiological and/or clinical observations. There was a significant association between an increased requirement for multiple brain passes and ventricular involvement in the trajectory (p < 0.01). Conclusions Planning an electrode trajectory that avoids the ventricles is a simple precaution that significantly improves the accuracy of anatomical targeting during electrode placement for deep brain stimulation. Avoidance of the ventricles appears to reduce the need for multiple passes through the brain to reach the desired target as defined by clinical and physiological observations.

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