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

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.

scholarly journals Deep Brain Stimulation Hardware Infections: A Case Series

2020 ◽  
Vol 8 (C) ◽  
pp. 172-176
Author(s):  
Hulagu Kaptan ◽  
Furkan Yuzbasi ◽  
Fatih Özturk ◽  
Haluk Vayvada
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Pulse Generator ◽  
Case Series ◽  
Electrode Placement ◽  
Device Removal ◽  
Surgical Wound ◽  
Wound Site ◽  
Special Circumstances ◽  
Deep Brain

BACKGROUND: The device-related infections and erosion of the surgical wound site are special circumstances among complications of deep brain stimulation (DBS). AIM: We aimed to discuss different aspects of hardware infections and contribute to the literature by presenting our treatment methods on four patients. MATERIAL AND METHODS: This study was carried out in the Department of Neurosurgery, School of Medicine Hospital, Dokuz Eylul University. Four DBS cases were included in the study, and a retrospective study was performed. RESULTS: Electrode placement to bilateral subthalamic nuclei was performed due to Parkinson’s Disease to all four patients. One of the patients was undergone surgical wound site revision 6 times and device removal at last due to device-related infection and erosion of the surgical wound site. The second patient was undergone surgical wound site revision for 2 times and device removal at last due to device-related infection and erosion of the surgical wound site. The third patient had a collection subcutaneously, where the pulse generator was placed. The collection was aspirated. The fourth patient was undergone surgical wound site revision and device removal at last due to device-related infection and erosion of the surgical wound site. All four patients were given IV antibiotics. CONCLUSION: For the treatment of DBS device-related infections, a long-term IV antibiotherapy is a suitable option before the decision of device removal.

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

2020 ◽  
Vol 133 (2) ◽  
pp. 403-410 ◽  
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.

Subthalamic nucleus deep brain stimulation for the treatment of secondary dystonia: A case series and review of literature

2017 ◽  
Vol 10 (4) ◽  
pp. 870-872 ◽  
Author(s):  
Jason Margolesky ◽  
Nathan Schoen ◽  
Walter Jermakowicz ◽  
Samir Sur ◽  
Iahn Cajigas ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Case Series ◽  
Review Of Literature ◽  
Secondary Dystonia ◽  
Deep Brain

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

2013 ◽  
Vol 124 (3) ◽  
pp. 166-174 ◽  
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

Symptomatic Cystic Lesion Following Deep Brain Stimulation Surgery

2020 ◽  
pp. 37-40
Author(s):  
Vibhash D. Sharma ◽  
Shilpa Chitnis
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Rare Complication ◽  
Cyst Formation ◽  
Management Options ◽  
Unexplained Symptoms ◽  
The Common ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Deep brain stimulation therapy is an effective therapy for selected patients with movement disorders. The procedure is relatively safe, but complications related to the surgical procedure or implanted hardware can occur. The common complications include hemorrhage, infarct, infection, and confusion. Noninfectious cyst formation around the DBS lead is a rare but potential complication of this procedure, which can occur several weeks to months after DBS lead implantation. This chapter describes a case of noninfectious cyst formation at the tip of DBS lead in a patient with essential tremor. Clinical presentation, role of imaging, and the management options for this rare complication are discussed. This case also illustrates the importance of post-DBS imaging in suspected cases with new or unexplained symptoms.

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

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
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.

scholarly journals Predictors of second-sided deep brain stimulation for Parkinson’s disease

2020 ◽  
pp. 1-7
Author(s):  
Joshua L. Golubovsky ◽  
Hong Li ◽  
Arbaz Momin ◽  
Jianning Shao ◽  
Maxwell Y. Lee ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Intraoperative Complications ◽  
Cohort Analysis ◽  
Initial Surgery ◽  
Patient Reported ◽  
Deep Brain

OBJECTIVEParkinson’s disease (PD) is a progressive neurological movement disorder that is commonly treated with deep brain stimulation (DBS) surgery in advanced stages. The purpose of this study was to investigate factors that affect time to placement of a second-sided DBS lead for PD when a unilateral lead is initially placed for asymmetrical presentation. The decision whether to initially perform unilateral or bilateral DBS is largely based on physician and/or patient preference.METHODSThis study was a retrospective cohort analysis of patients with PD undergoing initial unilateral DBS for asymmetrical disease between January 1999 and December 2017 at the authors’ institution. Patients treated with DBS for essential tremor or other conditions were excluded. Variables collected included demographics at surgery, time since diagnosis, Unified Parkinson’s Disease Rating Scale motor scores (UPDRS-III), patient-reported quality-of-life outcomes, side of operation, DBS target, intraoperative complications, and date of follow-up. Paired t-tests were used to assess mean changes in UPDRS-III. Cox proportional hazards analysis and the Kaplan-Meier method were used to determine factors associated with time to second lead insertion over 5 years.RESULTSThe final cohort included 105 patients who underwent initial unilateral DBS for asymmetrical PD; 59% of patients had a second-sided lead placed within 5 years with a median time of 34 months. Factors found to be significantly associated with early second-sided DBS included patient age 65 years or younger, globus pallidus internus (GPi) target, and greater off-medication reduction in UPDRS-III score following initial surgery. Older age was also found to be associated with a smaller preoperative UPDRS-III levodopa responsiveness score and with a smaller preoperative to postoperative medication-off UPDRS-III change.CONCLUSIONSYounger patients, those undergoing GPi-targeted unilateral DBS, and patients who responded better to the initial DBS were more likely to undergo early second-sided lead placement. Therefore, these patients, and patients who are more responsive to medication preoperatively (as a proxy for DBS responsiveness), may benefit from consideration of initial bilateral DBS.

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