Acta Neurochirurgica

, Volume 152, Issue 2, pp 195–200

Skin complications in deep brain stimulation for Parkinson’s disease: frequency, time course, and risk factors

  • Friederike Sixel-Döring
  • Claudia Trenkwalder
  • Christoph Kappus
  • Dieter Hellwig
Clinical Article

Abstract

Purpose

Deep brain stimulation (DBS) has been recognized as an efficacious treatment for movement disorders. Its beneficial effects however may be lost due to skin complications such as erosions or infections over the implanted foreign material. We sought to document skin complications in the entire Parkinson’s disease patient population who received a DBS system at the Marburg/Kassel implantation centre since the start of our DBS program in January 2002 to analyze frequency, time course, and possible risk factors.

Methods

We investigated 85 consecutive patients with Parkinson’s disease (PD) from a single center/single surgeon DBS series for the occurrence of skin complications and analyzed localization, time course, and possible risk factors. Mean follow-up was 3 years (range 1-7 years).

Results

In total, 21/85 patients (24.7%) suffered a total of 30 single skin complications. Sixty percent of all incidents occurred within the first post-operative year. Forty percent of all incidents occurred later than the first year following primary implantation. Complications involved the burr hole cap in 37%, the course of the cables in 33%, and the impulse generator (IPG) site in 30%. Six of 21 patients suffered recurring skin complications. Eight patients permanently lost their DBS system. Factor analysis for age, gender, disease duration, disease severity, the incidence of hypertension or diabetes as well as a 2-day period with externalized electrodes for continuous test stimulation did not have any statistically significant impact on skin complications.

Conclusions

We conclude that (1) PD patients have a risk for skin complications after DBS as long as the system remains in situ and (2) there are at present no identifiable risk factors for skin complications after DBS, other than PD itself.

Keywords

Deep brain stimulation Parkinson’s disease Skin erosions and infections 

References

  1. 1.
    Bhatia S, Oh M, Whiting T, Quigley M, Whiting D (2008) Surgical complications of deep brain stimulation. A longitudinal single surgeon, single institution study. Stereotact Funct Neurosurg 86:367–372CrossRefPubMedGoogle Scholar
  2. 2.
    Blomstedt P, Hariz MI (2005) Hardware-related complications of deep brain stimulation: a ten year experience. Acta Neurochir (Wien) 147:1061–1064 discussion 1064CrossRefGoogle Scholar
  3. 3.
    Constantoyannis C, Berk C, Honey CR, Mendez I, Brownstone RM (2005) Reducing hardware-related complications of deep brain stimulation. Can J Neurol Sci 32:194–200PubMedGoogle Scholar
  4. 4.
    Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schafer H, Botzel K, Daniels C, Deutschlander A, Dillmann U, Eisner W, Gruber D, Hamel W, Herzog J, Hilker R, Klebe S, Kloss M, Koy J, Krause M, Kupsch A, Lorenz D, Lorenzl S, Mehdorn HM, Moringlane JR, Oertel W, Pinsker MO, Reichmann H, Reuss A, Schneider GH, Schnitzler A, Steude U, Sturm V, Timmermann L, Tronnier V, Trottenberg T, Wojtecki L, Wolf E, Poewe W, Voges J (2006) A randomized trial of deep-brain stimulation for Parkinson's disease. N Engl J Med 355:896–908CrossRefPubMedGoogle Scholar
  5. 5.
    Driver JA, Logroscino G, Buring JE, Gaziano JM, Kurth T (2007) A prospective cohort study of cancer incidence following the diagnosis of Parkinson's disease. Cancer Epidemiol Biomarkers Prev 16:1260–1265CrossRefPubMedGoogle Scholar
  6. 6.
    Eisner W, Wolf E, Sohm F (2008) Infections in DBS. Proceedings of the XVIII Meeting of the ESSFN in Rimini, Italy 5.–8.10.2008. Acta Neurochir (Wien) 150:933–1012CrossRefGoogle Scholar
  7. 7.
    Ferreira J, Silva JM, Freire R, Pignatelli J, Guedes LC, Feijo A, Rosa MM, Coelho M, Costa J, Noronha A, Hewett R, Gomes AM, de Castro JL, Rascol O, Sampaio C (2007) Skin cancers and precancerous lesions in Parkinson's disease patients. Mov Disord 22:1471–1475CrossRefPubMedGoogle Scholar
  8. 8.
    Goodman RR, Kim B, McClelland S III, Senatus PB, Winfield LM, Pullman SL, Yu Q, Ford B, McKhann GM II (2006) Operative techniques and morbidity with subthalamic nucleus deep brain stimulation in 100 consecutive patients with advanced Parkinson's disease. J Neurol Neurosurg Psychiatry 77:12–17CrossRefPubMedGoogle Scholar
  9. 9.
    Hamani C, Lozano AM (2006) Hardware-related complications of deep brain stimulation: a review of the published literature. Stereotact Funct Neurosurg 84:248–251CrossRefPubMedGoogle Scholar
  10. 10.
    Ikemura M, Saito Y, Sengoku R, Sakiyama Y, Hatsuta H, Kanemaru K, Sawabe M, Arai T, Ito G, Iwatsubo T, Fukayama M, Murayama S (2008) Lewy body pathology involves cutaneous nerves. J Neuropathol Exp Neurol 67:945–953CrossRefPubMedGoogle Scholar
  11. 11.
    Joint C, Nandi D, Parkin S, Gregory R, Aziz T (2002) Hardware-related problems of deep brain stimulation. Mov Disord 17(Suppl 3):S175–S180CrossRefPubMedGoogle Scholar
  12. 12.
    Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, Koudsie A, Limousin PD, Benazzouz A, LeBas JF, Benabid AL, Pollak P (2003) Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 349:1925–1934CrossRefPubMedGoogle Scholar
  13. 13.
    Kupsch A, Benecke R, Muller J, Trottenberg T, Schneider GH, Poewe W, Eisner W, Wolters A, Muller JU, Deuschl G, Pinsker MO, Skogseid IM, Roeste GK, Vollmer-Haase J, Brentrup A, Krause M, Tronnier V, Schnitzler A, Voges J, Nikkhah G, Vesper J, Naumann M, Volkmann J (2006) Pallidal deep-brain stimulation in primary generalized or segmental dystonia. N Engl J Med 355:1978–1990CrossRefPubMedGoogle Scholar
  14. 14.
    Lyons KE, Wilkinson SB, Overman J, Pahwa R (2004) Surgical and hardware complications of subthalamic stimulation: a series of 160 procedures. Neurology 63:612–616PubMedGoogle Scholar
  15. 15.
    Oh MY, Abosch A, Kim SH, Lang AE, Lozano AM (2002) Long-term hardware-related complications of deep brain stimulation. Neurosurgery 50:1268–1274 discussion 1274-1266CrossRefPubMedGoogle Scholar
  16. 16.
    Pena E, Pastor J, Hernando V, Gallego I, Pedrosa M, Carrasco R, Sola RG (2008) Skin erosion over implants in deep brain stimulation patients. Stereotact Funct Neurosurg 86:120–126CrossRefPubMedGoogle Scholar
  17. 17.
    Schuurman PR, Bosch DA, Bossuyt PM, Bonsel GJ, van Someren EJ, de Bie RM, Merkus MP, Speelman JD (2000) A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med 342:461–468CrossRefPubMedGoogle Scholar
  18. 18.
    Sillay KA, Larson PS, Starr PA (2008) Deep brain stimulator hardware-related infections: incidence and management in a large series. Neurosurgery 62:360–366 discussion 366-367CrossRefPubMedGoogle Scholar
  19. 19.
    Sixel-Doring F, Trenkwalder C, Kappus C, Hellwig D (2006) Abscess at the implant site following apical parodontitis. Hardware-related complications of deep brain stimulation. Nervenarzt 77:946–947CrossRefPubMedGoogle Scholar
  20. 20.
    Temel Y, Ackermans L, Celik H, Spincemaille GH, van der Linden C, Walenkamp GH, van de Kar T, Visser-Vandewalle V (2004) Management of hardware infections following deep brain stimulation. Acta Neurochir (Wien) 146:355–361 discussion 361CrossRefGoogle Scholar
  21. 21.
    Umemura A, Jaggi JL, Hurtig HI, Siderowf AD, Colcher A, Stern MB, Baltuch GH (2003) Deep brain stimulation for movement disorders: morbidity and mortality in 109 patients. J Neurosurg 98:779–784CrossRefPubMedGoogle Scholar
  22. 22.
    Voges J, Waerzeggers Y, Maarouf M, Lehrke R, Koulousakis A, Lenartz D, Sturm V (2006) Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery–experiences from a single centre. J Neurol Neurosurg Psychiatry 77:868–872CrossRefPubMedGoogle Scholar
  23. 23.
    Weaver FM, Follett K, Stern M, Hur K, Harris C, Marks WJ Jr, Rothlind J, Sagher O, Reda D, Moy CS, Pahwa R, Burchiel K, Hogarth P, Lai EC, Duda JE, Holloway K, Samii A, Horn S, Bronstein J, Stoner G, Heemskerk J, Huang GD (2009) Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA 301:63–73CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Friederike Sixel-Döring
    • 1
  • Claudia Trenkwalder
    • 1
  • Christoph Kappus
    • 2
  • Dieter Hellwig
    • 2
  1. 1.Paracelsus-Elena-KlinikCenter of Parkinsonism and Movement DisordersKasselGermany
  2. 2.Neurochirurgie der Philipps-UniversitätMarburgGermany

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