Abstract
Infection constitutes a serious adverse event in patients submitted to deep brain stimulation, often leading to removal of the device. We set to evaluate the potential role of immunoscintigraphy with 99mTc-labelled antigranulocyte antibody fragments (99mTc-sulesomab) in the management of infection following DBS. 99mTc-sulesomab immunoscintigraphy seems to correlate well with the presence and extent of infection, thus contributing to differentiate between patients who should remove the hardware entirely at presentation and those who could undergo a more conservative approach. Also, 99mTc-sulesomab immunoscintigraphy has a role in determining the most appropriate timing for reimplantation. Finally, we propose an algorithm for the management of infection following DBS surgery, based on the results of the 99mTc-sulesomab immunoscintigraphy.
Highlights
Deep brain stimulation (DBS) is an effective treatment option for a number of neurological disorders, including movement disorders, pain, and epilepsy [1,2,3,4]
We propose an algorithm for the management of infection following DBS surgery, based on the results of the 99mTc-sulesomab immunoscintigraphy
Because the rate of skin complications is higher in patients with Parkinson’s disease (PD) than in patients with other diagnoses, it has been suggested that skin alterations in relation to PD itself could contribute to the occurrence of this adverse event [11, 12]
Summary
Deep brain stimulation (DBS) is an effective treatment option for a number of neurological disorders, including movement disorders, pain, and epilepsy [1,2,3,4]. Infection constitutes a serious adverse event because it often leads to removal of the DBS system, with consequent loss of the clinical benefits of stimulation. From an economical perspective, infection greatly adds to the costs of DBS treatment, as this complication often requires hospitalization, prolonged antibiotic therapy, and additional surgical procedures. In a pooled analysis of ten studies concerning hardware-related complications of DBS, which included 922 patients, hardware removal was necessary in 80% of the patients who developed infections [5]. Reports of successful conservative treatment with antibiotics alone seem to indicate that removal of the stimulation device is not always necessary and that conservative treatment could be considered as first choice in cases of circumscribed extracranial hardware infections [7]. The evaluation of the true extent of the extracranial infection can be troublesome in clinical practice and the decision of which patients are candidates for a conservative medical approach in contrast to immediate surgical treatment is usually not sufficiently clear-cut
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