Complications of deep brain stimulation

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A new study shows that the highest risks associated with primary deep brain stimulation implants are those related to the implants rather than to the actual procedure of their placement in the brain.

Shahid M Nimjee, Duke University Medical Center, Durham, USA, presented the results of a retrospective analysis involving 162 patients at the 14 Annual Meeting of the North American Neuromodulation Society, Las Vegas, USA. He said that the risks of deep brain stimulation are similar in scope to similar neuroprosthetic devices proposed for the treatment of movement disorders, including cortical brain stimulation and spinal cord stimulation.


Deep brain stimulation has proved to be a highly useful treatment for tremor and Parkinson’s disease in controlled trials, yet requires the implant of both electrode leads into specific brain regions, and a control unit containing a battery.


“Complications can arise from the brain placement of the leads (i.e. haemorrhage, stroke), systemic risks associated with a major surgical procedure, as well as infection, wound or electrode migration issues associated with the neurostimulator device,” said Nimjee.


The investigators analysed data from patients being followed at their institution for movement disorders. The patients had undergone deep brain stimulator insertion between 1997 and 2009 either at their own institution, or initially at another institution before transferring their care. Complete electronic records were available for review, including follow-up visits.


The results of the retrospective single institution data of primary deep brain stimulation implants (n=162 patients, n=301 leads) confirmed the low rates of brain and deep brain stimulation specific haemorrhagic complications. “We found 2.5% haemorrhagic complications on routine CT scans postoperatively which were mainly asymptomatic neurologically. There were 1.2% systemic complications. The device-related complications were:  infection (4.9%); dehiscence (1.9%);  and lead revision (3%),” he said. In contrast, battery replacement procedures (n=109) showed minimal complications and no infections.


 “Clearly, the highest risks of primary deep brain stimulation implants are those related to the implants rather than their placement. These risks are similar is scope to similar neuroprosthetic devices proposed for treatment of movement disorders, including cortical brain stimulations and spinal cord stimulation. Unlike deep brain stimulation, these suggested alternative sites for neuromodulation have much less demonstrated efficacy despite similar overall risks,” Nimjee concluded.

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