Complications of deep brain stimulation: a collective review.
Chan DT, Zhu XL, Yeung JH, Mok VC, Wong E, Lau C, Wong R, Lau C, Poon WS. Complications of deep brain stimulation: a collective review. , Asian Journal of Surgery 2009 Oct; 32(4):258-63.
The purpose of this article was to discuss what these authors have learned from completing the DBS surgery as well as to discuss the possible complications as well as what can be done to prevent such difficulties while moving forward with this treatment. The authors reviewed their cases from 1997-2008 and broke the complications into those related to the surgery, the hardware, or the stimulation and provided discussion of each as follows:
- One complication during the surgery involved having to move the DBS electrode to determine the best placement which increased the risk of hemorrhages. In their patient group, less than 1% experienced a hemorrhage. They suggested that the best way to prevent such complication was to extensively plan the surgery, utilize imaging techniques, and continue to develop surgical equipment that minimized the invasive nature of the surgery.
- Another complication from the surgery involves poor positioning of the electrode for a variety of reasons that reduced the efficacy of the treatment. Prevention techniques for this complication include intraoperative recording of brain activity as well as improved surgical devices that keep the electrode placed in the correct position. Approximately 2% of their patients experienced this complication.
- The authors found that approximately 10% of their patients had electrodes that fractured, short circuited, or moved from their original placement site. Reasons included improper tightening of the devices that hold the electrode in place as well as not enough tightening in other areas. One patient experienced a fall that also led to the electrode moving from the original site. Prevention techniques include improvement in the surgical devices as well as improved education and experience of the surgeons as they completed more and more of the surgeries.
- Infection is a concern for any surgery involving placement of a foreign body/device into one’s body. DBS surgery is no different and this study found approximately 10% of the patients experienced an infection related to the surgery and electrode placement. The infections were usually detected very early and all of the patients that had infections had the implants removed. The authors suggest that prevention of infections by taking precautions before the surgery is of utmost importance (e.g. antibiotics, antiseptic shampoo, etc.).
- A common stimulator complication is stimulation of surrounding tissues of the STN or GPi that cause a variety of motor and non-motor complications (e.g. speech, blinking, cognitive, psychiatric, weight gain, etc.). Prevention techniques include changing stimulator settings and monitoring of patient’s condition for such complications. Additionally, making sure that the patients are good surgical candidates and that they do not have pre-existing conditions (e.g. psychiatric or cognitive) that would worsen the chance of complications after the surgery.
- Patients with DBS also have to be cautious and alert about having the stimulator and undergoing other medical procedures that may interfere with or cause damage to the stimulator or surrounding areas (specifics mentioned were radiofrequency and monopolar diathermy used in some dental procedures). Prevention possibilities include that patients be given a card or other way of identifying that they have DBS as well as that they receive education on the importance of letting their medical professionals know about their surgical history.
In general regarding prevention of complications in DBS, many studies, including this one, strongly suggest using a multidisciplinary approach with a team dedicated to the treatment of movement disorders is very beneficial in order to minimize complications and maximize efficacy of DBS.