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Perioperative Emergencies Associated with Deep Brain Stimulation

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Movement Disorder Emergencies

Abstract

Deep brain stimulation (DBS) has become an established procedure for movement and neuropsychiatric disorders. With the increased use of DBS, DBS-related problems have emerged as more common, and awareness of these issues has become more important for clinicians. Adverse events vary widely depending on the situation. We deal only with emergent situations here and separate the possible scenarios into: (1) perioperative (intra- and early postoperative) and (2) postoperative (following 2–4 weeks) settings. With ten clinical vignettes, we address how clinicians should appropriately detect and manage the emergent/urgent issues in a DBS cohort.

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References

  1. Boviatsis EJ, Stavrinou LC, Themistocleous M, Kouyialis AT, Sakas DE. Surgical and hardware complications of deep brain stimulation: a seven-year experience and review of the ­literature. Acta Neurochir (Wien). 2010;152:2053–62.

    Article  Google Scholar 

  2. Morishita T, Foote KD, Burdick AP, et al. Identification and management of deep brain stimulation intra- and postoperative urgencies and emergencies. Parkinsonism Relat Disord. 2010;16:153–62.

    Article  PubMed  Google Scholar 

  3. Morishita T, Burdick A, Okun MS, Jacobson C, Foote KD. Cerebral venous infarction: an avoidable complication of deep brain stimulation surgery. In: The Movement Disorder Society’s 13th International Congress of Parkinson’s Disease and Movement Disorders. Paris; 2009.

    Google Scholar 

  4. Okun MS, Rodriguez RL, Foote KD, et al. A case-based review of troubleshooting deep brain stimulator issues in movement and neuropsychiatric disorders. Parkinsonism Relat Disord. 2008;14:532–8.

    Article  PubMed  Google Scholar 

  5. Hooper AK, Ellis TM, Foote KD, Zeilman P, Okun MS. Dyskinetic storm induced by intra-operative deep brain stimulator placement. Open Neurosurg J. 2009;2:1–3.

    Article  Google Scholar 

  6. Hooper AK, Okun MS, Foote KD, et al. Venous air embolism in deep brain stimulation. Stereotact Funct Neurosurg. 2009;87:25–30.

    Article  PubMed  Google Scholar 

  7. Burdick AP, Fernandez HH, Okun MS, Chi YY, Jacobson C, Foote KD. Relationship between higher rates of adverse events in deep brain stimulation using standardized prospective recording and patient outcomes. Neurosurg Focus. 2010;29(2):E4.

    Article  PubMed  Google Scholar 

  8. Burdick AP, Okun MS, Haq IU, et al. Prevalence of Twiddler’s syndrome as a cause of deep brain stimulation hardware failure. Stereotact Funct Neurosurg. 2010;88:353–9.

    Article  PubMed  Google Scholar 

  9. Resnick AS, Foote KD, Rodriguez RL, et al. The number and nature of emergency department encounters in patients with deep brain stimulators. J Neurol. 2010;257:122–31.

    Article  PubMed  Google Scholar 

  10. Ellis TM, Foote KD, Fernandez HH, et al. Reoperation for suboptimal outcomes after deep brain stimulation surgery. Neurosurgery. 2008;63:754–60. discussion 60–61.

    Article  PubMed  Google Scholar 

  11. Oyama G, Okun MS, Zeisevicz TA, et al. Delayed clinical improvement after deep brain stimulation-related subdural hematoma. J Neurosurg. 2011;115(2):289–94.

    Article  PubMed  Google Scholar 

  12. Deuschl G, Schade-Brittinger C, Krack P, et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med. 2006;355:896–908.

    Article  PubMed  CAS  Google Scholar 

  13. Krack P, Batir A, Van Blercom N, et al. Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med. 2003;349:1925–34.

    Article  PubMed  CAS  Google Scholar 

  14. Kupsch A, Benecke R, Müller J, et al. Pallidal deep-brain stimulation in primary generalized or segmental dystonia. N Engl J Med. 2006;355:1978–90.

    Article  PubMed  CAS  Google Scholar 

  15. Okun MS, Fernandez HH, Wu SS, et al. Cognition and mood in Parkinson’s disease in subthalamic nucleus versus globus pallidus interna deep brain stimulation: the COMPARE trial. Ann Neurol. 2009;65:586–95.

    Article  PubMed  Google Scholar 

  16. Kiss ZH, Doig-Beyaert K, Eliasziw M, et al. The Canadian multicentre study of deep brain stimulation for cervical dystonia. Brain. 2007;130:2879–86.

    Article  PubMed  Google Scholar 

  17. Kenney C, Simpson R, Hunter C, et al. Short-term and long-term safety of deep brain stimulation in the treatment of movement disorders. J Neurosurg. 2007;106:621–5.

    Article  PubMed  Google Scholar 

  18. Hariz MI. Complications of deep brain stimulation surgery. Mov Disord. 2002;17 Suppl 3:S162–6.

    Article  PubMed  Google Scholar 

  19. Chang WS, Kim HY, Kim JP, Park YS, Chung SS, Chang JW. Bilateral subthalamic deep brain stimulation using single track microelectrode recording. Acta Neurochir (Wien). 2011;153: 1087–95.

    Article  Google Scholar 

  20. Binder DK, Rau GM, Starr PA. Risk factors for hemorrhage during microelectrode-guided deep brain stimulator implantation for movement disorders. Neurosurgery. 2005;56:722–32.

    Article  PubMed  Google Scholar 

  21. Sansur CA, Frysinger RC, Pouratian N, et al. Incidence of symptomatic hemorrhage after stereotactic electrode placement. J Neurosurg. 2007;107:998–1003.

    Article  PubMed  Google Scholar 

  22. Beric A, Kelly PJ, Rezai A, et al. Complications of deep brain stimulation surgery. Stereotact Funct Neurosurg. 2001;77:73–8.

    Article  PubMed  CAS  Google Scholar 

  23. Lyons KE, Wilkinson SB, Overman J, Pahwa R. Surgical and hardware complications of subthalamic stimulation: a series of 160 procedures. Neurology. 2004;63:612–6.

    Article  PubMed  Google Scholar 

  24. Videnovic A, Metman LV. Deep brain stimulation for Parkinson’s disease: prevalence of adverse events and need for standardized reporting. Mov Disord. 2008;23:343–9.

    Article  PubMed  Google Scholar 

  25. Gorgulho A, De Salles AA, Frighetto L, Behnke E. Incidence of hemorrhage associated with electrophysiological studies performed using macroelectrodes and microelectrodes in functional neurosurgery. J Neurosurg. 2005;102:888–96.

    Article  PubMed  Google Scholar 

  26. Voges J, Hilker R, Botzel K, et al. Thirty days complication rate following surgery performed for deep-brain-stimulation. Mov Disord. 2007;22:1486–9.

    Article  PubMed  Google Scholar 

  27. Simuni T, Jaggi JL, Mulholland H, et al. Bilateral stimulation of the subthalamic nucleus in patients with Parkinson disease: a study of efficacy and safety. J Neurosurg. 2002;96:666–72.

    Article  PubMed  Google Scholar 

  28. Chang EF, Cheng JS, Richardson RM, Lee C, Starr PA, Larson PS. Incidence and management of venous air embolisms during awake deep brain stimulation surgery in a large clinical series. Stereotact Funct Neurosurg. 2011;89:76–82.

    Article  PubMed  Google Scholar 

  29. Deogaonkar A, Avitsian R, Henderson JM, Schubert A. Venous air embolism during deep brain stimulation surgery in an awake supine patient. Stereotact Funct Neurosurg. 2005;83: 32–5.

    Article  PubMed  Google Scholar 

  30. Mann JM, Foote KD, Garvan CW, et al. Brain penetration effects of microelectrodes and DBS leads in STN or GPi. J Neurol Neurosurg Psychiatry. 2009;80:794–7.

    Article  PubMed  CAS  Google Scholar 

  31. Morishita T, Foote KD, Wu SS, et al. Brain penetration effects of microelectrodes and deep brain stimulation leads in ventral intermediate nucleus stimulation for essential tremor. J Neurosurg. 2010;112:491–6.

    Article  PubMed  Google Scholar 

  32. Tasker RR. Deep brain stimulation is preferable to thalamotomy for tremor suppression. Surg Neurol. 1998;49:145–53. discussion 53–54.

    Article  PubMed  CAS  Google Scholar 

  33. Frucht SJ. Movement disorder emergencies in the perioperative period. Neurol Clin. 2004;22:379–87.

    Article  PubMed  Google Scholar 

  34. Poston KL, Frucht SJ. Movement disorder emergencies. J Neurol. 2008;255 Suppl 4:2–13.

    Article  PubMed  Google Scholar 

  35. Rodriguez RL, Fernandez HH, Haq I, Okun MS. Pearls in patient selection for deep brain stimulation. Neurologist. 2007;13:253–60.

    Article  PubMed  Google Scholar 

  36. Tune LE, Damlouji NF, Holland A, Gardner TJ, Folstein MF, Coyle JT. Association of postoperative delirium with raised serum levels of anticholinergic drugs. Lancet. 1981;2:651–3.

    Article  PubMed  CAS  Google Scholar 

  37. Deuschl G, Herzog J, Kleiner-Fisman G, et al. Deep brain stimulation: postoperative issues. Mov Disord. 2006;21 Suppl 14:S219–37.

    Article  PubMed  Google Scholar 

  38. Okun MS, Green J, Saben R, Gross R, Foote KD, Vitek JL. Mood changes with deep brain stimulation of STN and GPi: results of a pilot study. J Neurol Neurosurg Psychiatry. 2003;74:1584–6.

    Article  PubMed  CAS  Google Scholar 

  39. Hariz MI, Rehncrona S, Quinn NP, Speelman JD, Wensing C. Multicenter study on deep brain stimulation in Parkinson’s disease: an independent assessment of reported adverse events at 4 years. Mov Disord. 2008;23:416–21.

    Article  PubMed  Google Scholar 

  40. Okun MS, Rodriguez RL, Mikos A, et al. Deep brain stimulation and the role of the neuropsychologist. Clin Neuropsychol. 2007;21:162–89.

    Article  PubMed  Google Scholar 

  41. Poewe W. When a Parkinson’s disease patient starts to hallucinate. Pract Neurol. 2008;8:238–41.

    Article  PubMed  Google Scholar 

  42. Capelle HH, Simpson Jr RK, Kronenbuerger M, Michaelsen J, Tronnier V, Krauss JK. Long-term deep brain stimulation in elderly patients with cardiac pacemakers. J Neurosurg. 2005;102:53–9.

    PubMed  Google Scholar 

  43. Burton DA, Nicholson G, Hall GM. Anaesthesia in elderly patients with neurodegenerative disorders: special considerations. Drugs Aging. 2004;21:229–42.

    Article  PubMed  CAS  Google Scholar 

  44. Appleby BS, Duggan PS, Regenberg A, Rabins PV. Psychiatric and neuropsychiatric adverse events associated with deep brain stimulation: a meta-analysis of ten years’ experience. Mov Disord. 2007;22:1722–8.

    Article  PubMed  Google Scholar 

  45. Voon V, Krack P, Lang AE, et al. A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson’s disease. Brain. 2008;131:2720–8.

    Article  PubMed  Google Scholar 

  46. Foncke EM, Schuurman PR, Speelman JD. Suicide after deep brain stimulation of the internal globus pallidus for dystonia. Neurology. 2006;66:142–3.

    Article  PubMed  CAS  Google Scholar 

  47. Burkhard PR, Vingerhoets FJ, Berney A, Bogousslavsky J, Villemure JG, Ghika J. Suicide after successful deep brain stimulation for movement disorders. Neurology. 2004;63:2170–2.

    Article  PubMed  CAS  Google Scholar 

  48. Ghika J, Villemure JG, Miklossy J, et al. Postanoxic generalized dystonia improved by bilateral Voa thalamic deep brain stimulation. Neurology. 2002;58:311–3.

    Article  PubMed  CAS  Google Scholar 

  49. Doshi PK, Chhaya N, Bhatt MH. Depression leading to attempted suicide after bilateral subthalamic nucleus stimulation for Parkinson’s disease. Mov Disord. 2002;17:1084–5.

    Article  PubMed  Google Scholar 

  50. Blomstedt P, Hariz MI, Lees A, et al. Acute severe depression induced by intraoperative stimulation of the substantia nigra: a case report. Parkinsonism Relat Disord. 2008;14:253–6.

    Article  PubMed  Google Scholar 

  51. Bejjani BP, Damier P, Arnulf I, et al. Transient acute depression induced by high-frequency deep-brain stimulation. N Engl J Med. 1999;340:1476–80.

    Article  PubMed  CAS  Google Scholar 

  52. Miyawaki E, Perlmutter JS, Troster AI, Videen TO, Koller WC. The behavioral complications of pallidal stimulation: a case report. Brain Cogn. 2000;42:417–34.

    Article  PubMed  CAS  Google Scholar 

  53. Romito LM, Raja M, Daniele A, et al. Transient mania with hypersexuality after surgery for high frequency stimulation of the subthalamic nucleus in Parkinson’s disease. Mov Disord. 2002;17:1371–4.

    Article  PubMed  Google Scholar 

  54. Sillay KA, Larson PS, Starr PA. Deep brain stimulator hardware-related infections: incidence and management in a large series. Neurosurgery. 2008;62:360–6. discussion 6–7.

    Article  PubMed  Google Scholar 

  55. Joint C, Nandi D, Parkin S, Gregory R, Aziz T. Hardware-related problems of deep brain stimulation. Mov Disord. 2002;17 Suppl 3:S175–80.

    Article  PubMed  Google Scholar 

  56. Kondziolka D, Whiting D, Germanwala A, Oh M. Hardware-related complications after placement of thalamic deep brain stimulator systems. Stereotact Funct Neurosurg. 2002;79: 228–33.

    Article  PubMed  Google Scholar 

  57. Oh MY, Abosch A, Kim SH, Lang AE, Lozano AM. Long-term hardware-related complications of deep brain stimulation. Neurosurgery. 2002;50:1268–74. discussion 74–76.

    PubMed  Google Scholar 

  58. Blomstedt P, Hariz MI. Hardware-related complications of deep brain stimulation: a ten year experience. Acta Neurochir (Wien). 2005;147:1061–4.

    Article  CAS  Google Scholar 

  59. Koller W, Pahwa R, Busenbark K, et al. High-frequency unilateral thalamic stimulation in the treatment of essential and parkinsonian tremor. Ann Neurol. 1997;42:292–9.

    Article  PubMed  CAS  Google Scholar 

  60. Miller JP, Acar F, Burchiel KJ. Significant reduction in stereotactic and functional neurosurgical hardware infection after local neomycin/polymyxin application. J Neurosurg. 2009;110: 247–50.

    Article  PubMed  Google Scholar 

  61. Yianni J, Nandi D, Shad A, Bain P, Gregory R, Aziz T. Increased risk of lead fracture and migration in dystonia compared with other movement disorders following deep brain stimulation. J Clin Neurosci. 2004;11:243–5.

    Article  PubMed  CAS  Google Scholar 

  62. Gelabert-Gonzalez M, Relova-Quinteiro JL, Castro-Garcia A. “Twiddler syndrome” in two patients with deep brain stimulation. Acta Neurochir. 2010;152:489–91.

    Article  Google Scholar 

  63. Piacentini S, Romito L, Franzini A, Granato A, Broggi G, Albanese A. Mood disorder following DBS of the left amygdaloid region in a dystonia patient with a dislodged electrode. Mov Disord. 2008;23:147–50.

    Article  PubMed  Google Scholar 

  64. Geissinger G, Neal JH. Spontaneous Twiddler’s syndrome in a patient with a deep brain stimulator. Surg Neurol. 2007;68:454–6.

    Article  PubMed  Google Scholar 

  65. Machado AG, Hiremath GK, Salazar F, Rezai AR. Fracture of subthalamic nucleus deep brain stimulation hardware as a result of compulsive manipulation: case report. Neurosurgery. 2005;57:E1318.

    Article  PubMed  Google Scholar 

  66. Hariz MI, Johansson F. Hardware failure in parkinsonian patients with chronic subthalamic nucleus stimulation is a medical emergency. Mov Disord. 2001;16:166–8.

    Article  PubMed  CAS  Google Scholar 

  67. Hariz MI, Shamsgovara P, Johansson F, Hariz G, Fodstad H. Tolerance and tremor rebound following long-term chronic thalamic stimulation for Parkinsonian and essential tremor. Stereotact Funct Neurosurg. 1999;72:208–18.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Takashi Morishita M.D., Ph.D. .

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Morishita, T., Burdick, A.P., Okun, M.S. (2013). Perioperative Emergencies Associated with Deep Brain Stimulation. In: Frucht, S. (eds) Movement Disorder Emergencies. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-835-5_20

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  • DOI: https://doi.org/10.1007/978-1-60761-835-5_20

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