scholarly journals Anaesthesia and deep brain stimulation

2016 ◽  
Vol 03 (03) ◽  
pp. 197-204 ◽  
Author(s):  
Barkha Bindu ◽  
Parmod Bithal
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Surgical Procedure ◽  
Minimally Invasive Surgical Procedure ◽  
Clear Cut ◽  
Minimally Invasive Surgical ◽  
Proper Patient Selection ◽  
Anaesthesia Care ◽  
Risk Benefit Analysis ◽  
Deep Brain

AbstractDeep brain stimulation (DBS) is becoming an increasingly popular minimally invasive surgical procedure for various movement disorders, especially Parkinson’s disease. Different nuclei have been identified depending on patients’ symptoms, but the success or failure of the procedure depends on various other factors such as proper patient selection and risk-benefit analysis. While various techniques of anaesthesia including monitored anaesthesia care, conscious sedation and general anaesthesia are being used routinely, no clear-cut evidence exists as to the best technique for this procedure. This review article discusses the surgical procedure of DBS, devices currently available, perioperative anaesthetic concerns and techniques, effect of anaesthetic drugs on microelectrode recordings and macro-stimulation and associated complications.

scholarly journals Placement of the Internal Pulse Generator for Deep Brain Stimulation in the Upper Back to Prevent Fracture of the Extension Wire due to Generator Rotation: Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Ankur Garg ◽  
Avinash L. Mohan ◽  
P. Charles Garell
Keyword(s):  
Case Report ◽  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Surgical Procedure ◽  
Pulse Generator ◽  
Potential Complication ◽  
Hardware Failure ◽  
Internal Pulse Generator ◽  
Deep Brain

Deep brain stimulation (DBS) is a common surgical procedure used for the treatment of Parkinson's disease (PD) and essential tremor. A potential complication of this procedure is hardware failure. The authors report a case of DBS hardware failure in which repeated fractures of the extension wire were caused by abnormal rotational movements of the IPG placed in the loose subclavicular tissue of an overweight female. Implantation of the IPG in the suprascapular area prevented further extension wire fractures. This strategy may be especially relevant in overweight females with loose subclavicular tissue.

scholarly journals Deep brain stimulation modulates the dynamics of resting-state networks in patients with Parkinson’s Disease

2020 ◽  
Author(s):  
Maria T. Gomes ◽  
Henrique M. Fernandes ◽  
Joana Cabral
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Electric Field ◽  
Brain Stimulation ◽  
Resting State ◽  
Surgical Procedure ◽  
Resting State Networks ◽  
Stn Dbs ◽  
Deep Brain

ABSTRACTDeep brain stimulation (DBS) of the subthalamic nucleus (STN) is increasingly used for the treatment of Parkinson’s Disease (PD), but despite its success, the neural mechanisms behind this surgical procedure remain partly unclear. As one working hypothesis, it was proposed that DBS works by restoring the balance of the brain’s resting-state networks (RSNs), which is reported to be disrupted in people with PD. Hence, to elucidate the effects that STN-DBS induces on disseminated networks, we analyzed an fMRI dataset of 20 PD patients at rest under DBS ON and OFF conditions. Moving beyond ‘static’ functional connectivity studies, we employ a recently developed fMRI analysis tool, the Leading Eigenvector Dynamic Analysis (LEiDA), to characterize the recurrence of brain-wide phase-locking patterns overlapping with known RSNs. Here, STN-DBS seems to increase the Default Mode Network (DMN) occurrence in individuals with PD. Since the DMN is usually disturbed in PD patients presenting deficits in cognition, our observation might be suggestive that STN-DBS contributes to a normalization of the PD-induced cognitive impairment.Moreover, we addressed the effects of DBS lead placement on RSNs balance, considering the overlap between the DBS-induced electric field and 3 STN subsections. We found that the Visual Network (VN) probability of occurrence increased proportionally to the electric field-limbic STN overlap. Our finding might be indicative that stimulation of the limbic STN is related to the stabilization of visual symptoms sometimes presented by PD patients, which are usually accompanied by VN disruption.Overall, this study offers new insights into the fine-grained temporal dynamics of brain states portraying the effects of STN-DBS in patients with PD, while at the same time trying to pave the way to improved planning strategies for this surgical procedure.

scholarly journals Deep Brain Stimulation Utilizing Dexmedetomidine: A Clinical Report from the University of Miami Miller School of Medicine

2016 ◽  
Vol 03 (03) ◽  
pp. 233-238
Author(s):  
Derek Covington ◽  
Meredith Degnan ◽  
Yiliam Rodriguez-Blanco ◽  
Ankeet Choxi ◽  
Rupa Prasad ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Perioperative Complications ◽  
Anesthetic Management ◽  
Clinical Report ◽  
School Of Medicine ◽  
Perioperative Complication ◽  
Anaesthesia Care ◽  
The University ◽  
Deep Brain

Abstract Background: Deep brain stimulation (DBS) is an increasingly utilized technique to treat symptoms of neurological movement disorders, most commonly, Parkinson’s Disease. Patients and surgeons alike appreciate the minimally invasive nature of this procedure, as well as its reversibility. As these surgeries are being performed more often, it is becoming increasingly important to optimize our anesthetic management during these cases. Methods: We conducted a retrospective review of the DBS procedures that have been performed at our institution utilizing monitored anaesthesia care (MAC) via dexmedetomidine infusion to report on the frequency and type of perioperative complications as well as to assess the effectiveness of this technique. Results: A total of 150 patients and 174 lead placements were included in this study. Dexmedetomidine was the sole anaesthetic used in 85.6% of cases. The remaining cases used a combination of dexmedetomidine and adjuvant agents. A total of one perioperative complication was found in our series, resulting in a total complication rate percentage per patient of 0.6%.Conclusions: We found very few perioperative complications associated with the use of dexmedetomidine during these challenging cases. With its anxiolytic, sedative, and analgesic properties coupled with preservation of respiration and a short half-life, dexmedetomidine has ideal properties for DBS procedures.

scholarly journals Risk of Infection after Deep Brain Stimulation Surgery with Externalization and Local-Field Potential Recordings: Twelve-Year Experience from a Single Institution

2021 ◽  
pp. 1-9
Author(s):  
Lucia K. Feldmann ◽  
Wolf-Julian Neumann ◽  
Katharina Faust ◽  
Gerd-Helge Schneider ◽  
Andrea A. Kühn
Keyword(s):  
Deep Brain Stimulation ◽  
Local Field ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Local Field Potential ◽  
Surgical Procedure ◽  
Field Potential ◽  
Risk Of Infection ◽  
Large Patient ◽  
Deep Brain

<b><i>Introduction:</i></b> Deep brain stimulation (DBS) has been an established surgical procedure in the field of functional neurosurgery for many years. The experimental electrophysiological method of local field potential (LFP) recordings in postsurgically externalized patients has made substantial contributions to the better understanding of pathophysiologies underlying movement disorders. As interest in LFP recordings for the development of improved stimulation strategies increases, this study’s aim was to provide evidence concerning safety of this research method, in a major DBS center. <b><i>Methods:</i></b> We retrospectively analyzed incidence and infection characteristics in adult patients who underwent two-staged DBS surgery with temporary externalization of leads in our center between January 2008 and November 2019. We focused on whether patients had participated in LFP recordings, and evaluated incidence of infections at 3 months and 1 year after the surgery based on medical records. Infection rates were compared to major DBS studies and reports focusing on the risk of infection due to externalization of DBS leads. Results were visualized using descriptive statistics. <b><i>Results:</i></b> Between January 2008 and November 2019, DBS surgery was performed in 528 patients (389/139 patients in the LFP/non-LFP group), mainly for movement disorders such as Parkinson’s disease (308), dystonia (93), and essential tremor (86). Of the patients, 72.9% participated in LFP recordings. The incidence of infections in the acute postsurgical phase (3 months) was 2.46% and did not differ significantly between the LFP group (1.8%) and the non-LFP group (4.32%). The overall incidence after 1 year amounted to 3.6% (19 patients) with no difference between LFP/non-LFP groups. Incidence rates reported in the literature show a large variety (2.6–10%), and the incidence reported here is within the lower range of reported incidences. <b><i>Discussion/Conclusion:</i></b> This study demonstrates that DBS is a surgical procedure with a low risk of infection in a large patient cohort. Importantly, it shows that LFP recordings do not have a significant effect on the incidence of infections in patients with externalization. With a representative cohort of more than 380 patients participating in LFP-recordings, this underlines LFP as a safe method in research and supports further use of this method, for example, for the development of adaptive stimulation protocols.

Neuropsychiatric consequences of deep brain stimulation surgeries in the patients affected by chronic movement disorders: A brief report

2016 ◽  
Vol 33 (S1) ◽  
pp. S94-S95
Author(s):  
S. Mahdavi ◽  
S.K. Malakouti ◽  
B. Naji ◽  
M. Asadi ◽  
S. Kahani
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Verbal Fluency ◽  
Surgical Procedure ◽  
Digit Span ◽  
Significant Deterioration ◽  
Surgery Patient ◽  
One Year ◽  
Deep Brain

The main surgical procedure for PD and other chronic movement disorders is deep brain stimulation. DBS has been reported to have specific consequences such as decline in verbal fluency and episodes of depression.We designed an interventional study in 12 patients affected by Parkinson, dystonia and tic who underwent DBS surgery. Patient assessed before surgery, one month and one year after surgery.The results proved a significant improvement in SF36. The Hamilton's anxiety scale showed an overall but insignificant improvement. The mean of scores of the BDI had a great drop one month after surgery but a raise at the 12th month (insignificant pattern).Pearson's correlation test showed a significant negative correlation between age and the SF36 scores. The BDI's scores were assessed in relation with age. Although there was no actual relation between them before surgery, we detected a positive correlation between them after one year.ConclusionThe pattern of changes can be related with the differences between perioperative expectations and real long-term outcomes. Correlations between changes seen in BDI and SF36 scores with age can be considered as a confirmatory evidence for this idea.All cases showed an insignificant gradual decline in digit span test, which may be independent of the surgical procedure. Although the COWA test could not prove a significant deterioration in verbal fluency but a slight decline after one year was obvious, in addition to one patient who turned aphasic during this period.The outcomes showed that the benefits of DBS outweigh the slight risk of developing depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Deep Brain Stimulation for Essential Tremor

2020 ◽  
pp. 17-22
Author(s):  
Brent Bluett
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Patient Selection ◽  
Brain Stimulation ◽  
Constant Current ◽  
Current Steering ◽  
Optimal Outcomes ◽  
Proper Patient Selection ◽  
Independent Constant ◽  
Deep Brain

Essential tremor (ET) is one of the most common movement disorders and can result in disabling symptoms that are refractory to standard medications. In 1997, the US Food and Drug Administration approved deep brain stimulation (DBS) of the ventral intermedius nucleus of the thalamus for treatment of ET. DBS often reduces or eliminates the need for medications to treat ET. Proper patient selection and expertise in DBS programming are critical to ensure optimal outcomes. Recent advances in DBS include directional current steering and multisource independent constant current to program each electrode with its own power source. This chapter discusses proper patient selection, programming guidelines, and clinical pearls in DBS for ET.

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