Complications Of Deep Brain Stimulation Research Articles

Deep Brain Stimulation for Refractory Status Dystonicus in Children: Multi-Centre Case Series and Systematic Review.

We sought to better understand the workflow, outcomes, and complications of deep brain stimulation (DBS) for pediatric status dystonicus (SD). We present a systematic review, alongside a multi-center case series of pediatric patients with SD treated with DBS. We collected individual data regarding treatment, stimulation parameters, and dystonia severity for a multi-center case series (n=8) and all previously published cases (n=77). Data for case series was used to create probabilistic voxel-wise maps of stimulated tissue associated with dystonia improvement. In our institutional series, DBS was implanted a mean of 25 days post-SD onset. Programming began a mean of 1.6 days after surgery. All eight patients in our case series and 73/74 reported patients in the systematic review had resolution of their SD with DBS, most within 2-4 weeks of surgery. Mean follow-up for patients in the case series was 16 months. DBS target for all patients in the case series and 68/77 in our systematic review was the globus pallidus pars interna (GPi). In our case series, stimulation of the posterior-ventrolateral GPi was associated with improved dystonia. Mean dystonia improvement was 32% and 51% in our institutional series and systematic review, respectively. Mortality was 4% in the review, which is lower than reported for treatment with pharmacotherapy alone (10-12.5%). DBS is a feasible intervention with potential to reverse refractory pediatric SD and improve survival. More work is needed to increase awareness of DBS in this setting, so that it can be implemented in a timely manner. This article is protected by copyright. All rights reserved.

Complications of deep brain stimulation in Parkinson's disease: a single-center experience of 517 consecutive cases.

The number of deep brain stimulation (DBS) procedures is rapidly rising as well as the novel indications. Reporting adverse events related to surgery and to the hardware used is essential to define the risk-to-benefit ratio and develop novel strategies to improve it. To analyze DBS complications (both procedure-related and hardware-related) and further assess potential predictive factors. Five hundred seventeen cases of DBS for Parkinson's disease were performed between 2006 and 2021 in a single center (mean follow-up: 4.68 ± 2.86 years). Spearman's Rho coefficient was calculated to search for a correlation between the occurrence of intracerebral hemorrhage (ICH) and the number of recording tracks. Multiple logistic regression analyzed the probability of developing seizures and ICH given potential risk factors. Kaplan-Meier curves were performed to analyze the cumulative proportions of hardware-related complications. Mortality rate was 0.2%, while permanent morbidity 0.6%. 2.5% of cases suffered from ICH which were not influenced by the number of tracks used for recordings. 3.3% reported seizures that were significantly affected by perielectrode brain edema and age. The rate of perielectrode brain edema was significantly higher for Medtronic's leads compared to Boston Scientific's (Χ2(1)= 5.927, P= 0.015). 12.2% of implants reported Hardware-related complications, the most common of which were wound revisions (7.2%). Internal pulse generator models with smaller profiles displayed more favorable hardware-related complication survival curves compared to larger designs (X2(1)= 8.139, P= 0.004). Overall DBS has to be considered a safe procedure, but future research is needed to decrease the rate of hardware-related complications which may be related to both the surgical technique and to the specific hardware's design. The increased incidence of perielectrode brain edema associated with certain lead models may likewise deserve future investigation.

C.4 Understanding the role of deep brain stimulation for Refractory Status Dystonicus in children: case series and systematic review

Background: Status dystonicus (SD) is a life-threatening form of dystonia with limited treatments available. We sought to better understand the processes, outcomes, and complications of deep brain stimulation (DBS) for pediatric SD through a systematic review alongside an institutional case series. Methods: Data regarding treatment, stimulation parameters, dystonia severity and outcomes was collected for the case series (n=7) and systematic review (n=70, conducted in accordance with PRISMA guidelines). This was analysed descriptively (rates, outcome measures). For the case series we created probabilistic voxel-wise maps for improvement in dystonia based on brain region stimulated. Results: All patients in our case series and > 95% of patients in the systematic review had resolution of SD with DBS, typically within 2-4 weeks. Most patients in the review (84%) and all patients in the case series had DBS implanted to the globus pallidus internus. In terms of dystonia severity scores, there was a mean improvement of 25% (case series) or 49% (systematic review). Reported mortality was 4% in the systematic review. Conclusions: DBS for pediatric SD is feasible and safe. It allows for increased survival as well as quality of life - however risks still exist. More work is needed to determine timing, eligibility, and stimulation parameters.

Cyst Formation following DBS Electrode Placement: A Rare Complication (P5-11.011)

<h3>Objective:</h3> To present two cases of intraparenchymal cysts, a rare complication of deep brain stimulation (DBS) in patients with movement disorders. <h3>Background:</h3> Formation of an intraparenchymal cyst following DBS electrode placement is a very rare complication. Only a few case reports exist and as a result, there is paucity of knowledge on its etiology, pathogenesis, prevention and treatment. <h3>Design/Methods:</h3> A chart review was done on two cases that had intraparenchymal cyst formation following DBS electrode placement at our medical center. In addition, we reviewed the literature to compare with our cases. <h3>Results:</h3> Patient A is a 79 y.o. male who underwent a left VIM thalamic lead placement and Patient B is a 64 y.o. underwent bilateral VIM lead placement for essential tremor. Both patients had a period of improvement in tremor before starting to experience new neurological deficits about 10 months and 2 months after lead placement, respectively. Patient A experienced right foot weakness, right arm weakness, and subjective decline in cognition while Patient B experienced an acute episode of altered mental status in the emergency department while under cardiac monitoring. Upon imaging, a cyst was found at the tip of the DBS lead in Patient A’s left thalamus and Patient B’s right thalamus. Infectious workup was negative indicating the cysts to be non-infectious. The brain electrodes were removed in both patients with resolution of neurological deficits and cyst regression on repeat imaging. Patient A continued to have tremor suppression for a year despite electrode removal while Patient B had an immediate tremor return to the pre-DBS baseline. <h3>Conclusions:</h3> Electrode explanation resulted in cyst regression with resolution of right hemi-body weakness in Patient A and altered mental status in Patient B. There is a need for reporting this very rare complication of DBS surgery to better understand its etiology, pathogenesis, treatment and prognosis. <b>Disclosure:</b> Ms. Naing has nothing to disclose. Dr. Venkataraman has nothing to disclose. The institution of Dr. Tatter has received research support from Monteris Medical, Inc. The institution of Dr. Tatter has received research support from Arbor Pharmaceuticals. Dr. Tatter has received intellectual property interests from a discovery or technology relating to health care. Adrian Laxton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Monteris. Adrian Laxton has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Monteris . Dr. Siddiqui has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Boston Scientific Neuromodulation. Dr. Siddiqui has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie. The institution of Dr. Siddiqui has received research support from Boston Scientific Neuromodulation. The institution of Dr. Siddiqui has received research support from Abbvie. The institution of Dr. Siddiqui has received research support from Biogen. The institution of Dr. Siddiqui has received research support from Neuraly. The institution of Dr. Siddiqui has received research support from Abbvie.

Brain abscess in a patient with generalized dystonia after deep brain stimulation: illustrative case.

Infections related to deep brain stimulation (DBS) devices are not rare, but abscess formation in brain parenchyma is extremely rare. A 50-year-old man with generalized dystonia had undergone DBS of bilateral globus pallidus internus. The authors attempted to remove the bilateral DBS system due to repeated device infections caused by metal allergies. However, the intracranial lead had to be left in place, because the lead was strongly adherent to brain parenchyma. Five years later, magnetic resonance imaging showed ring-like enhancement localized around the tip of the intracranial lead, suggesting brain abscess. In response to the symptoms, the remaining left intracranial electrode was removed. Brain abscesses require several months of treatment with appropriate antibiotics, but good outcomes can be achieved with appropriate treatment. Brain abscess is a rare complication of DBS. In the present case, the infection spread from the subcutaneous infected foci to the intracranial area through the lead, resulting in the formation of a brain abscess. Removing as much of the device as possible from the body is therefore important, even if adhesions with brain parenchyma or other tissues are present, because of the risk of serious complications, as seen in this case.

Complications of Deep Brain Stimulation for Movement Disorders: Literature Review and Personal Experience.

The contemporary technique of deep brain stimulation (DBS) is very effective for management of movement disorders-including Parkinson's disease, generalized dystonia, and tremors-and has also been successfully applied for novel indications (e.g., intractable epilepsy and chronic pain). As a result, growing numbers of DBS procedures have been performed worldwide; correspondingly, the incidence of associated morbidity has also increased. All complications of DBS can be divided into those associated with (1) the surgical procedure, (2) the device itself, and (3) the applied electrical stimulation. On the basis of an analysis of the available literature and the personal experience of the author, it may be concluded that implantation of a DBS device is a relatively safe procedure accompanied by very low risks of major morbidity or a permanent neurological deficit. Nevertheless, awareness of the possible complications and application of appropriate preventive measures for their avoidance are very important for providing safe and effective treatment.

Cerebrospinal Fluid Leakage to the Chest Subcutaneous Pocket Due to Aggressive Brain Edema around the Leads for Deep Brain Stimulation: A Case Report and Literature Review

Cerebral edema around the lead has been reported as a complication of deep brain stimulation; however, the causes remain unknown. Herein, we present a rare case of sudden cerebral edema around the lead occurring after deep brain stimulation. This was accompanied by cerebrospinal fluid (CSF) leakage into the subcutaneous thoracic pocket around the implantable pulse generator in a 53-year-old man with Parkinson's disease. No such case has been reported thus far. Lumbar drainage was performed to improve CSF leakage. The cerebral edema initially responded to steroids, but then it stopped responding to treatment. The edema appeared alternately on the left and right sides, and cyst formation was noted around the left lead. There are some reports of cyst formation around the lead; however, in our case, images were used to monitor the edema and cyst from their appearance to their disappearance. Our data suggest that cyst formation and cerebral edema are related.

Complications of Deep Brain Stimulation for Parkinson Disease and Relationship between Micro-electrode tracks and hemorrhage: Systematic Review and Meta-Analysis

Deep brain stimulation is a common treatment for Parkinson's disease (PD). Despite strong efficacy in well-selected patients, complications can occur. Intraoperative micro-electrode recording (MER) can enhance efficacy by improving lead accuracy. However, there is controversy as to whether MER increases risk of hemorrhage. To provide a comprehensive systematic review and meta-analysis reporting complication rates from deep brain stimulation in PD. We also interrogate the association between hemorrhage and MER. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were implemented while querying the Pubmed, Embase, and Cochrane databases. All included studies were randomized controlled trials and prospective case series with 5 or more patients. Primary outcomes included rates of overall revision, infection, lead malposition, surgical site and wound complications, hardware-related complications, and seizure. The secondary outcome was the relationship between number of MER tracks and hemorrhage rate. 262 articles with 21,261 patients were included in the analysis. Mean follow-up was 25.8months (range 0-133). Complication rates were: revision 4.9%, infection 4.2%, lead malposition 3.3%, surgical site complications 2.8%, hemorrhage 2.4%, hardware-related complications 2.4%, and seizure 1.9%. While hemorrhage rate did not increase with single-track MER (odds ratio, 3.49; P= 0.29), there was a significant non-linear increase with each additional track. Infection and lead malposition were the most common complications. Hemorrhage risk increases with more than one MER track. These results highlight the challenge of balancing surgical accuracy and perioperative risk.

PO066 / #670 PERIOPERATIVE COMPLICATIONS OF DEEP BRAIN STIMULATION: E-POSTER VIEWING

Deep brain stimulation (DBS) is mainly used for movement disorders, but its indications are expanding to pain and a series of psychiatric diseases. We analyzed perioperative complications of DBS performed in a single center and the risk factors related to them.

What should we do to reduce the complications of Deep brain stimulation in Parkinson's disease?

Parkinson's Disease (PD) is one of the most common neurodegenerative disorders. Recently, Deep Brain Stimulation (DBS) was proposed as a potential therapeutic approach for PD patients. This procedure has side effects that can be divided into three categories: stimulation-related, surgery-related, and hardware-related side effects. Stimulation-related complications are also divided into motors such as paresthesia and dysarthria, while non-motor contains cognitive decline and depression. The most important complication related to surgery is intracerebral hemorrhage (ICH). Side effects related to Hardware consist mainly of erosion and infections. Choosing the appropriate patient for DBS implantation has a critical role in reducing side effects. Adaptive or closed-loop DBS stimulates the brain by adjusting the parameters in response to feedback from the body and produce electrical flow when it is. New directional leads provide the ability to shape and steer the current to avoid stimulation of unwanted regions. Using Magnetic resonance imaging (MRI) instead of Microelectrode Recording (MER) allows surgery under general anesthesia and reduces the risk of ICH. Also, Interleaving Stimulation (ILS) can be a second option for those patients whom conventional programming does not effective. Choosing the right trajectory and keeping a distance from the vascular areas during lead placement also reduces the risk of hemorrhage.Keywords: Deep brain stimulation, side effects, Adaptive DBS, Directional leads, Microelectrode recording, Parkinson's disease

Surgical and Hardware Complications of Deep Brain Stimulation—A Single Surgeon Experience of 519 Cases Over 20 Years

ObjectiveDeep brain stimulation (DBS) surgery has its own set of risks and complications. This study from a single center and a single surgeon analyzes various risk factors for complications and tries to establish if there is a learning curve effect in minimizing the complications. Materials and MethodsA retrospective analysis of 519 patients (1024 leads) who underwent DBS surgery and 232 patients who underwent implantable pulse generator replacement (IPG), by a single surgeon, between the years 1999 and 2019 was performed. Perioperative and hardware related complications were evaluated. ResultsThe follow-up period ranged from six months to 20 years. Surgery-related complications occurred in 46 (8.9%) cases which included confusion in 31 (5.98%), intracerebral hemorrhage in 7 (1.3%), vasovagal attack in 3 (0.58%), respiratory distress in 2 (0.38%), postoperative aggressiveness in 1 (0.19%), and blepharospasm in 2 (0.38%) patients. Complications related to the DBS hardware were found in 35 cases, including erosion and infection in 22 (2.95%), inaccurate lead placement or migration in 6 (0.6%) lead fracture/extension wire failure in 2 (0.26%), IPG malfunction in 2 (0.26%), and hardware discomfort in 3 (0.4%) cases. In three patients, one lead was repositioned. In cases of infection, 87% of patients had either partial or complete removal of hardware. There was no mortality. The complications were analyzed for every 100 DBS procedures. There was a significant drop in the percentage of complications in from 23% in the first 100 cases to 7% in the last 100 cases (p < 0.0001). ConclusionConfusion remains the most frequent operative and perioperative complication. Erosion and infection of the surgical site represents the most frequent hardware complication. DBS surgery is safe and the complication rates are acceptably low. The complication rate also decreases with cumulative years of experience, demonstrating a learning curve effect.

Use of Topical Vancomycin Powder to Reduce Surgical Site Infections after Deep Brain Stimulation Surgery: UCSF Experience and Meta-Analysis

Objective: Surgical site infection (SSI) is the most common serious complication of deep brain stimulation (DBS) implantation surgery. Here, we report a single-surgeon experience on the efficacy of topical, intrawound vancomycin powder (VP) in reducing SSI for DBS surgery and present the first systematic review and meta-analysis examining the effect of topical vancomycin on SSI in patients after DBS surgery. Methods: For the retrospective review, all unique patients undergoing DBS surgery at UCSF for new hardware implantation or internal pulse generator (IPG) replacement by a single surgeon from September 2013 to March 2019, with at least 1 year of follow-up data, were included. For the meta-analysis, we included all primary studies that compared SSIs with and without application of topical vancomycin in DBS surgeries. Results: 368 unique patients met inclusion criteria; 195 patients received topical VP (VP group) and 173 did not (control). 99/195 patients in the VP group underwent new DBS implantation and 96/195 had IPG replacement. 71/173 patients in the control group had new DBS implantation and 102/173 had IPG replacement. There were 10 total cases of SSI: 4 patients from the VP group (3 new implants and 1 IPG replacement) and 6 patients from the control group (3 new implants and 3 IPG replacements), resulting in SSI rates of 2.1 and 3.5%, respectively (p value = 0.337). Including our retrospective analysis, 6 studies met inclusion criteria for the systematic review and meta-analysis. In the 4 studies that examined primary DBS implants, 479 total patients received topical VP and 436 did not; mean odds ratio for SSI with topical vancomycin was 0.802 (95% confidence interval [CI] 0.175–3.678). Across the 5 studies that examined IPG implantations or replacements, 606 total patients received topical VP while 1,173 patients did not; mean odds ratio for SSI with topical vancomycin was 0.492 (95% CI 0.164–1.475). In either case, topical VP application did not significantly decrease risk of SSI. Conclusion: Surgical infections after DBS surgery are uncommon events, with studies demonstrating mixed results on whether topical vancomycin reduces this risk. Our single-institution retrospective analysis and systematic review of prior studies both demonstrated no significant SSI rate reduction with topical VP. This is likely due to low baseline SSI rates, resulting in a small effect size for prevention. Given the cost-effectiveness, simplicity, and low risk, topical, intrawound VP remains a treatment option to further reduce risk of SSI, particularly in settings with higher baseline infection rates.

Perioperative complications of deep brain stimulation among patients with advanced age: a single-institution retrospective analysis.

Deep brain stimulation (DBS) is an elective procedure that can dramatically enhance quality of life. Because DBS is not considered lifesaving, it is important that providers produce consistently good outcomes, and one factor they usually consider is patient age. While older age may be a relative contraindication for some elective surgeries, the progressive nature of movement disorders treated with DBS may suggest that older patients stand to benefit substantially from surgery. To better understand the risks of treating patients of advanced age with DBS, this study compares perioperative complication rates in patients ≥ 75 to those < 75 years old. Patients undergoing DBS surgery for various indications by a single surgeon (May 2013-July 2019) were stratified into elderly (age ≥ 75 years) and younger (age < 75 years) cohorts. The risks of common perioperative complications and various outcome measures were compared between the two age groups using risk ratios (RRs) and 95% confidence intervals (CIs). A total of 861 patients were available for analysis: 179 (21%) were ≥ 75 years old and 682 (79%) were < 75 years old (p < 0.001). Patients ≥ 75 years old, compared with those < 75 years old, did not have significantly different RRs (95% CIs) of seizure (RR 0.4, 95% CI 0.1-3.3), cerebrovascular accident (RR 1.9, 95% CI 0.4-10.3), readmission within 90 days of discharge (RR 1.22, 95% CI 0.8-1.8), explantation due to infection (RR 2.5, 95% CI 0.4-15.1), or surgical revision (for lead, RR 2.5, 95% CI 0.4-15.1; for internal pulse generator, RR 3.8, 95% CI 0.2-61.7). Although the risk of postoperative intracranial bleeding was higher in the elderly group (6.1%) than in the younger group (3.1%), this difference was not statistically significant (p = 0.06). However, patients ≥ 75 years old did have significantly increased risk of altered mental status (RR 2.5, 95% CI 1.6-4.0), experiencing more than a 1-night stay (RR 1.7, 95% CI 1.4-2.0), and urinary retention (RR 2.3, 95% CI 1.2-4.2; p = 0.009). Although elderly patients had higher risks of certain outcome measures than younger patients, this study showed that elderly patients undergoing DBS for movement disorders did not have an increased risk of more serious complications, such as intracranial hemorrhage, infection, or readmission. Advanced age alone should not be considered a contraindication for DBS.

A systematic review of Twiddler's syndrome: a hardware-related complication of deep brain stimulation.

Twiddler's syndrome (TS) is a hardware-related complication of deep brain stimulation which has not been well documented and is probably underreported. The objective of this study is to comprehensively describe TS by systematically reviewing the related literature. The methods include selecting the eligible studies based on the inclusion and exclusion criteria. Data about studies and TS were collected. A descriptive statistical analysis of the extracted data was performed. We found 18 eligible studies describing 23 patients with TS. The mean age of the 23 patients was 61.4 ± 15.9years (range, 16-79years.). The percentage of TS in the female population was 91.3% (females: 21/23). The incidence of postoperative TS was 1.4% (6 out of 437) per patient and 1.1% (8 out of 709) per extension wire. The mean time to clinical presentation was 9.9 ± 10.3months (range, 0.5-36months). Nineteen of the twenty-three patients presented with a rebound of previous symptoms. Twelve of the twenty-three patients had high impedance at the postoperative checkup of the DBS system. A plain X-ray indicated twisted extension wires in almost all these patients. All patients meeting the definition of postoperative device-related TS underwent revision surgery. TS is more prevalent in females. Based on the typical clinical symptoms (rebound of the previous symptoms, high impedance, and X-ray demonstration), the differential diagnosis can often be straightforward. TS should thus be taken into consideration when attempting to explain or rule out hardware malfunction. The timely recognition and proper revision of TS can prevent further serious damage.

Deep Brain Stimulation Complications in Patients With Parkinson's Disease and Surgical Modifications: A Single-Center Retrospective Analysis.

BackgroundAs a complication-prone operation, deep brain stimulation (DBS) has become the first-line surgical approach for patients with advanced Parkinson’s disease (PD). This study aimed to evaluate the incidence and risk factors of DBS-associated complications.MethodsWe have reviewed a consecutive series of patients with PD undergoing DBS procedures to describe the type, severity, management, and outcome of postoperative complications from January 2011 to December 2018. Both univariate and multivariate analyses were performed to identify statistically significant risk factors. We also described our surgical strategies to minimize the adverse events.ResultsA total of 225 patients underwent 229 DBS implantation procedures (440 electrodes), of whom 20 patients experienced 23 DBS-associated complications, including ten operation-related complications and 13 hardware-related ones. Univariate analysis elucidated that comorbid medical conditions (P = 0.024), hypertension (P = 0.003), early-stage operation (P < 0.001), and unilateral electrode implantation (P = 0.029) as risk factors for overall complications, or more specifically, operation-related complications demonstrated in the stratified analysis. In contrast, no risk factor for hardware-related complications was identified. Statistical significances of hypertension (OR = 3.33, 95% CI: 1.14–9.71, P = 0.027) and early-stage (OR = 11.04, 95% CI: 2.42–50.45, P = 0.002) were further validated via multivariate analysis. As the annual number of DBS procedures increased, the incidence of complications gradually decreased (R = −0.699, P < 0.01). Additionally, there was a strong correlation between surgical complications and unplanned readmission (R = 0.730, P < 0.01).ConclusionThe importance of cumulative experience and relevant technique modifications should be addressed to prevent DBS-associated complications and unplanned readmission.

Alternatives to Pharmacological and Psychotherapeutic Treatments in Psychiatric Disorders

Nowadays, most of the patients affected by psychiatric disorders are successfully treated with psychotherapy and pharmacotherapy. Nevertheless, according to the disease, a variable percentage of patients results resistant to such modalities, and alternative methods can then be considered. The purpose of this review is to summarize the techniques and results of invasive modalities for several treatment-resistant psychiatric diseases. A literature search was performed to provide an up-to-date review of advantages, disadvantages, efficacy, and complications of Deep-Brain Stimulation, Magnetic Resonance-guided Focused-Ultrasound, radiofrequency, and radiotherapy lesioning for depression, obsessive-compulsive disorder, schizophrenia, addiction, anorexia nervosa, and Tourette’s syndrome. The literature search did not strictly follow the criteria for a systematic review: due to the large differences in methodologies and patients’ cohort, we tried to identify the highest quality of available evidence for each technique. We present the data as a comprehensive, narrative review about the role, indication, safety, and results of the contemporary instrumental techniques that opened new therapeutic fields for selected patients unresponsive to psychotherapy and pharmacotherapy.

Eye Movement Network Originating from Frontal Eye Field: Electric Cortical Stimulation and Diffusion Tensor Imaging.

This study investigated the networks originating from frontal eye fields (FEFs) using electric cortical stimulation and diffusion tensor imaging (DTI). Seven patients with intractable focal epilepsy, in which FEFs were identified by electrical cortical stimulation, were enrolled in this study. Electric stimulation at 50 Hz was applied to the electrodes for functional mapping. DTI was used to identify the subcortical fibers originating from the FEFs with two regions of interests (ROIs) in the FEF and contralateral paramedian pontine reticular formation (PPRF). FEFs were found in the superior precentral sulcus (pre-CS) in six patients and superior frontal gyrus (SFG) in three patients. DTI detected fibers connecting FEFs and contralateral PPRFs, passing within the internal capsule. The fibers were located close to the lateral antero-superior border of the subthalamic nucleus (STN) and medial posterior border of the globus pallidus internus (GPi). This study found the characteristic subcortical networks of the FEF. These tracts should be noted to prevent complications of deep brain stimulation (DBS) of the STN or GPi.

Deep Brain Stimulation Hardware Infections: A Case Series

BACKGROUND: The device-related infections and erosion of the surgical wound site are special circumstances among complications of deep brain stimulation (DBS).&#x0D; AIM: We aimed to discuss different aspects of hardware infections and contribute to the literature by presenting our treatment methods on four patients.&#x0D; 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.&#x0D; 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.&#x0D; CONCLUSION: For the treatment of DBS device-related infections, a long-term IV antibiotherapy is a suitable option before the decision of device removal.

Deep Brain Stimulation for Tremor and Dystonia.

Deep brain stimulation (DBS) is the most commonly used surgical treatment for drug-refractory movement disorders such as tremor and dystonia. Appropriate patient selection along with target selection is important to ensure optimal outcome without complications. This review summarizes the recent literature regarding the mechanism of action, indications, outcome, and complications of DBS in tremor and dystonia. A comparison with other modalities of surgical interventions is discussed along with a note of the recent advances in technology. Future research needs to be directed to understand the underlying etiopathogenesis of the disease and the way in which DBS modulates the intracranial abnormal networks.

Investigating Risk Factors and Predicting Complications in Deep Brain Stimulation Surgery with Machine Learning Algorithms

Deep brain stimulation (DBS) surgery is an option for patients experiencing medically resistant neurologic symptoms. DBS complications are rare; finding significant predictors requires a large number of surgeries. Machine learning algorithms may be used to effectively predict these outcomes. The aims of this study were to 1) investigate preoperative clinical risk factors and 2) build machine learning models to predict adverse outcomes. This multicenter registry collected clinical and demographic characteristics of patients undergoing DBS surgery (n= 501) and tabulated occurrence of complications. Logistic regression was used to evaluate risk factors. Supervised learning algorithms were trained and validated on 70% and 30%, respectively, of both oversampled and original registry data. Performance was evaluated using area under the receiver operating characteristics curve (AUC), sensitivity, specificity, and accuracy. Logistic regression showed that the risk of complication was related to the operating institution in which the surgery was performed (odds ratio [OR]= 0.44, confidence interval [CI]= 0.25-0.78), body mass index (OR= 0.94, CI= 0.89-0.99), and diabetes (OR= 2.33, CI= 1.18-4.60). Patients with diabetes were almost 3×more likely to return to the operating room (OR= 2.78, CI= 1.31-5.88). Patients with a history of smoking were 4× more likely to experience postoperative infection (OR= 4.20, CI= 1.21-14.61). Supervised learning algorithms demonstrated high discrimination performance when predicting any complication (AUC= 0.86), a complication within 12 months (AUC= 0.91), return to the operating room (AUC= 0.88), and infection (AUC= 0.97). Age, body mass index, procedure side, gender, and a diagnosis of Parkinson disease were influential features. Multiple significant complication risk factors were identified, and supervised learning algorithms effectively predicted adverse outcomes in DBS surgery.