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

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Abstract

Background

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.

Objective

To analyze DBS complications (both procedure-related and hardware-related) and further assess potential predictive factors.

Methods

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.

Results

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).

Conclusion

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.

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Authors and Affiliations

  1. Neurosurgical Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy

    Domenico Servello, Tommaso Francesco Galbiati, Guglielmo Iess & Mauro Porta

  2. Parkinson’s Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy

    Brigida Minafra & Claudio Pacchetti

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  1. Domenico Servello
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  2. Tommaso Francesco Galbiati
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  3. Guglielmo Iess
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  4. Brigida Minafra
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  5. Mauro Porta
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  6. Claudio Pacchetti
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Domenico Servello, Tommaso Galbiati, and Guglielmo Iess. The first draft of the manuscript was written by Domenico Servello and Tommaso Galbiati and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tommaso Francesco Galbiati.

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Ethics approval

The work described has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans. All the patients signed a written informed consent for the specific procedure.

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The authors declare no competing interests.

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Comments

The present article discusses the relevant topic of possible complications in DBS surgery. I congratulate the authors on this paper, on their courage to critically evaluate and discuss their own interventions and results, and for making the readership aware of this important topic. An interesting and new aspect is the occurrence of edema around the electrodes and potential differences between the manufacturers and lead models, an issue to which more attention should certainly be paid in the future. As we know, problems, complications, and side-effects can in principle be caused by the procedures itself, by the implants inserted, or by the subsequent stimulations. Thus, all parties concerned, the neurosurgeons who perform the operations, the manufacturers of the hardware and software, and the neurologists providing further treatment are called upon to get involved to improve more and more the quality of DBS therapy and to further reduce the associated risks and complications.

Markus Florian Oertel

Zurich, Switzerland

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Servello, D., Galbiati, T.F., Iess, G. et al. Complications of deep brain stimulation in Parkinson’s disease: a single-center experience of 517 consecutive cases. Acta Neurochir 165, 3385–3396 (2023). https://doi.org/10.1007/s00701-023-05799-w

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