Abstract
BackgroundHardware-related infection in deep brain stimulation (DBS) is one of the most commonly reported complications frequently resulting in the removal of implantable pulse generator (IPG).ObjectiveThe aim of this study was to establish a useful strategy to better prevent and treat those infections and to improve the preservation rates of IPG.MethodsWe conducted a retrospective and historical controlled study of all adult patients (≥18 years old) who had undergone initial DBS implantation at a single center. All participants were enrolled in the control group (between June 2005 and June 2014) or intervention group (between July 2014 and May 2019) based on their surgery dates. We used the intraoperative irrigation with hydrogen dioxide solution in the intervention group. Based on the dates of diagnosis, patients with hardware-related infection after DBS were enrolled in group A (between June 2005 and June 2014) or group B (between July 2014 and May 2019). IPG-sparing algorithm (Isa) was applied for group B. The early-onset IPG infections of the control and intervention groups were evaluated. The IPG preservation rates in both groups A and B were statistically analyzed.ResultsSix cases of early IPG infection and subsequent IPG removal occurred in the control group, while none occurred after intraoperative usage of the hydrogen dioxide in the intervention group. IPG preservation rate of infected cases in group B was significantly higher than that in group A (70% vs.16%, p = 0.004).ConclusionThe combined application of hydrogen dioxide solution and Isa seems to be an effective strategy to prevent IPG infection.
Highlights
Deep brain stimulation (DBS) has been widely accepted as an effective treatment for a variety of movement disorders such as Parkinson’s disease (PD), essential tremor (ET), and dystonia
Six cases of early implantable pulse generator (IPG) infection and subsequent IPG removal occurred in the control group, while none occurred after intraoperative usage of the hydrogen dioxide in the intervention group
The IPGrelated infection was of particular concern to our patients given that the rechargeable IPG was widely used since the second half of 2014
Summary
Deep brain stimulation (DBS) has been widely accepted as an effective treatment for a variety of movement disorders such as Parkinson’s disease (PD), essential tremor (ET), and dystonia. The IPGrelated infection was of particular concern to our patients given that the rechargeable IPG was widely used since the second half of 2014. The cost of this new IPG type accounted for about 80% of the cost of the whole DBS system and it was higher than that of earlier non-rechargeable models, which was not covered by our national healthcare insurance system. Usage of rechargeable IPG (15-year warranty) implies a sustained risk of IPG infection. Hardware-related infection in deep brain stimulation (DBS) is one of the most commonly reported complications frequently resulting in the removal of implantable pulse generator (IPG)
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