Abstract
Background/AimsDeep brain stimulation (DBS) implant infection is a feared complication, as it is difficult to manage and leads to increased patient morbidity. We wanted to assess the frequency and possible risk factors of DBS related infections at our centre. In the purpose of evaluating treatment options, we also analyzed treatment, and the clinical and microbiological characteristics of the infections.MethodsElectronic medical records of all patients undergoing DBS surgery at our centre, from 2001 through 2010, were retrospectively reviewed.ResultsOf the 588 procedures performed 33 (5.6%) led to an infection. Some patients underwent several procedures, thus 32 out of totally 368 patients (8.7%), and 19 out of 285 patients (6.7%) who received primary lead implantation, developed an infection. Most infections (52%) developed within the first month and 79% within three months. In the majority of the infections (79%) hardware removal was performed. Staphylococcus aureus infections were the most frequent (36%), and more likely to have earlier onset, pus formation, a more aggressive development and lead to hardware removal. No risk factors were identified.ConclusionsOur results indicate that infections with more severe symptoms and growth of staphylococcus aureus should be treated with local hardware removal and antibiotic therapy. In other infections, an initial trial of antibiotic treatment could be considered. New knowledge about the microbiology of DBS related infections may lead to more effective antimicrobial treatment.
Highlights
Deep brain stimulation (DBS) has become an important treatment option in movement disorders resistant to medical treatment
Numbers of initial implantations have been quite stable, but there has been an increase in internal pulse generator (IPG) replacements, especially in 2010
The most frequent diagnosis was Parkinson’s disease (PD) with 270 patients (73%), tremor disorders follow with 60 patients (16%) and primary dystonia with 33 patients (9%)
Summary
Deep brain stimulation (DBS) has become an important treatment option in movement disorders resistant to medical treatment. Well-established indications are Parkinson’s disease (PD), essential tremor (ET) and dystonia. DBS is performed as an elective procedure, can be performed safely and is well tolerated by most. It is not without risk of complications, and system infection is a known problem [4]. As with any therapy involving permanent implants, infectious complications are feared, as they are difficult to manage. Infections are usually found at the site of the internal pulse generator (IPG), at the connector site or on the scalp where the lead exits the brain. Intracerebral infections are rare [5]
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