Deep brain stimulator complication

Background
  • FDA-approved for medication-refractory movement disorders (e.g. Parkinson's disease, dystonia, essential tremor) and OCD
  • Single lead systems implanted into the thalamus
  • Complication rates range from 7-65%[1]

Clinical Features/Complication Types
  • Infection
    • Usually early after placement
    • Infection rates ~3-10%[2]
  • Cerebral hemorrhage
  • Lead fracture or migration
  • Failure of device to improve tremor/motor symptoms
  • Paresthesias (temporary or permanent)
  • Dysarthria, decreased verbal fluency
  • Disequilibrium
  • Affective changes (depression, apathy), impaired executive function, impulsivity

Differential Diagnosis

Evaluation
  • May need to observe with device in "off" position to distinguish between device malfunction and other acute neurologic deficit

Management
  • Consult neurosurgery

Disposition

See Also

References
  1. Tabbal SD, Revilla FJ, Mink JW, et al. Safety and efficacy of subthalamic nucleus deep brain stimulation performed with limited intraoperative mapping for treatment of Parkinson's disease. Neurosurgery. 2007;61(3 Suppl):119-27.
  2. Tabbal SD, Revilla FJ, Mink JW, et al. Safety and efficacy of subthalamic nucleus deep brain stimulation performed with limited intraoperative mapping for treatment of Parkinson's disease. Neurosurgery. 2007;61(3 Suppl):119-27.
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