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BACKGROUND: Subthalamic nucleus deep brain stimulation (STN DBS) is an established therapy for Parkinson's disease (PD) patients suffering from motor response fluctuations despite optimal medical treatment, or severe dopaminergic side effects. Despite careful clinical selection and surgical procedures, some patients do not benefit from STN DBS. Preoperative prediction models are suggested to better predict individual motor response after STN DBS. We validate a preregistered model, DBS-PREDICT, in an external multicenter validation cohort. METHODS: DBS-PREDICT considered eleven, solely preoperative, clinical characteristics and applied a logistic regression to differentiate between weak and strong motor responders. Weak motor response was defined as no clinically relevant improvement on the Unified Parkinson's Disease Rating Scale (UPDRS) II, III, or IV, 1 year after surgery, defined as, respectively, 3, 5, and 3 points or more. Lower UPDRS III and IV scores and higher age at disease onset contributed most to weak response predictions. Individual predictions were compared with actual clinical outcomes. RESULTS: 322 PD patients treated with STN DBS from 6 different centers were included. DBS-PREDICT differentiated between weak and strong motor responders with an area under the receiver operator curve of 0.76 and an accuracy up to 77%. CONCLUSION: Proving generalizability and feasibility of preoperative STN DBS outcome prediction in an external multicenter cohort is an important step in creating clinical impact in DBS with data-driven tools. Future prospective studies are required to overcome several inherent practical and statistical limitations of including clinical decision support systems in DBS care.
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Estimulación Encefálica Profunda , Enfermedad de Parkinson , Núcleo Subtalámico , Estimulación Encefálica Profunda/métodos , Humanos , Enfermedad de Parkinson/cirugía , Pronóstico , Núcleo Subtalámico/cirugía , Resultado del TratamientoRESUMEN
Parkinson's disease (PD) is associated with degeneration of the dopaminergic neurons in the substantia nigra. The subthalamic nucleus (STN) plays a pivotal role in the pathogenesis. However, there is not much known about the morphological changes in the STN. The red nucleus (RN) has many connections with the motor coordinating pathways although it is not primarily involved in the pathogenesis. In this study we aimed to compare the volumes of the STN and RN measured by magnetic resonance imaging in PD patients and controls to investigate how these structures are affected at the morphological level. Twenty patients with PD and twenty age/sex matched controls were enrolled in this study. Severity score was determined by Hoehn & Yahr staging: 6 at stage II and 14 at stage III in med-off state. Imaging was performed by a 1.5 Tesla (T) MR scanner. Measurements of total brain and normalized STN and RN volumes were performed by manual planimetry using Image J software. No statistically significant differences were observed between two groups based on age or gender and disease stage and nuclei volumes. The total estimated brain volumes were not different between PD patients and controls. However, normalized volumes of the STN and RN were 14% and 16% larger, respectively, in PD patients compared to the controls (p < 0.05). Our findings suggest that the volumes of the STN and RN are increased in patients with PD. These changes possibly reflect the altered metabolic activity of these regions demonstrated by neurophysiological studies.
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Enfermedad de Parkinson/patología , Núcleo Rojo/patología , Núcleo Subtalámico/patología , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Hipertrofia/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , NeuroimagenRESUMEN
Parkinson's disease, a progressive neurodegenerative disorder predominantly affecting elderly, is marked by the gradual degeneration of the nigrostriatal dopaminergic pathway, culminating in neuronal loss within the substantia nigra pars compacta (SNpc) and dopamine depletion. At the molecular level, neuronal loss in the SNpc has been attributed to factors including neuroinflammation, impaired protein homeostasis, as well as mitochondrial dysfunction and the resulting oxidative stress. This review focuses on the interplay between neuroinflammatory pathways and Parkinson's disease, drawing insights from current literature.
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Enfermedad de Parkinson , Humanos , Anciano , Enfermedad de Parkinson/metabolismo , Enfermedades Neuroinflamatorias , Sustancia Negra/metabolismo , Estrés Oxidativo , Dopamina/metabolismo , Neuronas Dopaminérgicas/metabolismoRESUMEN
Parkinson's disease, a progressive neurodegenerative disorder, involves gradual degeneration of the nigrostriatal dopaminergic pathway, leading to neuronal loss within the substantia nigra pars compacta and dopamine depletion. Molecular factors, including neuroinflammation, impaired protein homeostasis, and mitochondrial dysfunction, contribute to the neuronal loss. Deep brain stimulation, a form of neuromodulation, applies electric current through stereotactically implanted electrodes, effectively managing motor symptoms in advanced Parkinson's disease patients. Deep brain stimulation exerts intricate effects on neuronal systems, encompassing alterations in neurotransmitter dynamics, microenvironment restoration, neurogenesis, synaptogenesis, and neuroprotection. Contrary to initial concerns, deep brain stimulation demonstrates antiinflammatory effects, influencing cytokine release, glial activation, and neuronal survival. This review investigates the intricacies of deep brain stimulation mechanisms, including insertional effects, histological changes, and glial responses, and sheds light on the complex interplay between electrodes, stimulation, and the brain. This exploration delves into understanding the role of neuroinflammatory pathways and the effects of deep brain stimulation in the context of Parkinson's disease, providing insights into its neuroprotective capabilities.
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Estimulación Encefálica Profunda , Enfermedad de Parkinson , Humanos , Enfermedad de Parkinson/metabolismo , Enfermedades Neuroinflamatorias , Dopamina/metabolismo , Encéfalo/metabolismo , Sustancia Negra/patologíaRESUMEN
Clinical and preclinical investigations suggest that epidural stimulation of the motor cortex (MC) can improve stroke-induced neurological deficits. The mechanisms involved in stimulation-induced recovery are not well understood and might involve neurogenesis-related processes. Here, we addressed the question whether MC stimulation influences processes of migration and differentiation of neuronal progenitor cells in vivo. Epidural stimulation electrodes were implanted at the level of the MC in rats, and electrical current was applied for a period of 1 month. Increased cell proliferation was observed in the subventricular zone (SVZ). We also found evidences for enhanced cell migration toward the source of current, a process known as electrotaxis. Some of these cells expressed the neuronal marker, NeuN. In addition, our results indicate that MC stimulation enhances neuronal activity of the dorsal raphe nucleus, leading to an increase in the expression of 5-hydroxytryptamine in the SVZ. It is known that such an increase can promote formation of new cells in the SVZ. Our findings suggest that epidural MC stimulation influences neurogenesis-related processes in animal models.
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Movimiento Celular/fisiología , Corteza Motora/citología , Corteza Motora/fisiología , Células-Madre Neurales/fisiología , Animales , Antimetabolitos , Bromodesoxiuridina , Proliferación Celular , Ventrículos Cerebrales/fisiología , Proteínas de Dominio Doblecortina , Estimulación Eléctrica , Electrodos Implantados , Espacio Epidural/fisiología , Inmunohistoquímica , Antígeno Ki-67/metabolismo , Masculino , Proteínas Asociadas a Microtúbulos/metabolismo , Neuropéptidos/metabolismo , Bulbo Olfatorio/fisiología , Proteínas Proto-Oncogénicas c-fos/biosíntesis , Ratas , Ratas Sprague-DawleyRESUMEN
Alzheimer's disease (AD) is the most common type of dementia that causes disabilities in memory formation and activities of daily living. Unfortunately, pharmacologic treatments have minimal and short-lasting effects on AD. With the increasing aging population, investigations into therapeutic strategies for AD that lead to a delay in disease progression would significantly reduce the global burden of AD. Deep brain stimulation (DBS) is considered therapeutic for several conditions, such as movement disorders and some psychiatric diseases. Preclinical and clinical studies that used DBS as a treatment modality demonstrate the safety of DBS in AD and suggest potential memory improvements after surgery. Nevertheless, more studies are needed to understand the therapeutic mechanism of DBS. In this review, we summarize studies on DBS in various targets for AD and discuss DBS-induced changes in neurogenesis and pathological markers in AD.
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Enfermedad de Alzheimer , Estimulación Encefálica Profunda , Actividades Cotidianas , Anciano , Enfermedad de Alzheimer/terapia , Estimulación Encefálica Profunda/efectos adversos , Humanos , NeurogénesisRESUMEN
AIM: To investigate the effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on acoustic characteristics of voice production in Turkish patients with Parkinson's disease (PD). MATERIAL AND METHODS: This study recruited 20 patients diagnosed with PD. Voice samples were recorded under the "stimulation on" and "stimulation off" conditions of STN-DBS. Acoustic recordings of the patients were made during the production of vowels /a/, /o/, and /i/ and repetition of the syllables /pa/-/ta/-/ka/. Acoustic analyses were performed using Praat. RESULTS: A significant difference in the parameters was observed among groups for vowels. A positive significant difference was observed between preoperative med-on and postoperative med-on/stim-on groups for /a/ and the postoperative med-on/ stim-on and postoperative med-on/stim-off groups for /o/ and /i/ for frequency perturbation (jitter) and noise-to-harmonics ratio. No significant difference was noted between the preoperative med-on and postoperative med-on/stim-off groups for any vowels. CONCLUSION: STN-DBS surgery has an acute positive effect on voice. Studies on formant frequency analysis in STN-DBS may be expanded with both articulation and intelligibility tests to enable us to combine patient abilities in various perspectives and to obtain precise results.
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Estimulación Encefálica Profunda , Enfermedad de Parkinson , Núcleo Subtalámico , Estimulación Encefálica Profunda/métodos , Humanos , Lenguaje , Enfermedad de Parkinson/cirugía , Núcleo Subtalámico/fisiología , Núcleo Subtalámico/cirugíaRESUMEN
AIM: Deep brain stimulation (DBS) is a well-established treatment option for improving function and quality of life (QoL) in carefully selected patients with Parkinson?s disease (PD). Patient selection is a crucial step that should be performed by an experienced multidisciplinary team according to the proposed inclusion and exclusion criteria to increase the QoL of patients. CASE REPORT: A 47-year-old bedridden woman with a 20-year history of PD presented with levodopa-unresponsive tremor and severe axial symptoms. Despite various antiparkinsonian medications, a suboptimal improvement was observed with the levodopa challenge test. After detailed evaluations, she underwent bilateral subthalamic nucleus DBS. During the 2-year follow-up, her axial symptoms improved significantly leading to a better QoL. CONCLUSION: Although levodopa-resistant axial symptoms are considered a relative contraindication to DBS surgery, this case report demonstrates that with an interdisciplinary approach and an accurate assessment of symptoms, even bedridden and latestage selected PD cases may benefit from DBS.
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Estimulación Encefálica Profunda , Enfermedad de Parkinson , Núcleo Subtalámico , Femenino , Humanos , Levodopa/uso terapéutico , Persona de Mediana Edad , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/terapia , Calidad de Vida , Núcleo Subtalámico/fisiología , Núcleo Subtalámico/cirugía , Resultado del TratamientoRESUMEN
AIM: To examine the postoperative outcomes of electrode fixation using bone cement and Stimloc® in patients with Parkinson?s disease (PD) who underwent subthalamic nucleus (STN) deep brain stimulation (DBS). MATERIAL AND METHODS: Between 2016 and 2018, permanent electrode fixation was performed in 30 patients with PD, of which 15 received bone cement and the remaining 15 received Stimloc®. Data regarding preoperative Unified Parkinson?s Disease Rating Scale (UPDRS) III scores, levodopa equivalent daily dose (LEDD) values, surgery duration, and the fixation technique used were recorded. Brain computed tomography was performed for early postoperative evaluation of pneumocephalus and possible hematoma as well as for the determination of migration 1 year postoperatively. UPDRS III scores and LEDD values were re-evaluated 1 year postoperatively; surgery duration, clinical effectiveness, and complication rates were compared between the two fixation techniques. RESULTS: A statistically significant difference in application time was observed between the two techniques (bone cement: 21 min, Stimloc®: 6 min). After 1 year from surgery, 0.92- and 0.88-mm migrations were observed in the bone cement and Stimloc® groups, respectively. A significant correlation between migration and the pneumocephalus volume was observed in both groups. No differences were observed between the groups regarding infection, migration, pneumocephalus volume, wound erosion, and clinical outcomes. CONCLUSION: Stimloc® is preferred over bone cement for electrode fixation in DBS surgeries as it is associated with shorter application duration; this increases patient comfort and tolerance during awake surgery. Clinical efficacy and complication rates associated with both techniques are similar.
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Neoplasias Encefálicas , Estimulación Encefálica Profunda , Enfermedad de Parkinson , Neumocéfalo , Cementos para Huesos/uso terapéutico , Neoplasias Encefálicas/complicaciones , Estimulación Encefálica Profunda/métodos , Electrodos , Humanos , Levodopa , Enfermedad de Parkinson/cirugía , Neumocéfalo/complicaciones , Resultado del Tratamiento , VigiliaRESUMEN
OBJECTIVE: Deep brain stimulation (DBS) is a frequently applied therapy in primary dystonia. For secondary dystonia, the effects can be less favorable. We share our long-term findings in 9 patients with severe secondary dystonia and discuss these findings in the light of the literature. METHODS: Patients who had undergone globus pallidus internus (GPi)-DBS for secondary dystonia were included. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores, clinical improvement rates, follow-up periods, stimulation parameters and the need for internal pulse generator replacements were analyzed. The PubMed and Google Scholar databases were searched for articles describing GPi-DBS and subthalamic nucleus (STN)-DBS only for secondary dystonia cases. Keywords were "dystonia," "deep brain stimulation," "GPi," "dystonia," "deep brain stimulation," and "STN." RESULTS: A total of 9 secondary dystonia patients (5 male, 4 female) had undergone GPi-DBS with microelectrode recording in our units. The mean follow-up period was 29 months. The average BFMDRS score was 58.2 before the surgery, whereas the mean value was 36.5 at the last follow-up of the patients (mean improvement, 39%; minimum, 9%; maximum, 63%). In the literature review, we identified 264 GPi-DBS cases (mean follow-up, 19 months) in 72 different articles about secondary dystonia. The mean BFMDRS improvement rate was 52%. In 146 secondary dystonia cases, reported in 19 articles, STN-DBS was performed. The average follow-up period was 20 months and the improvement in BFMDRS score was 66%. CONCLUSIONS: Although GPi-DBS has favorable long-term efficacy and safety in the treatment of patients with secondary dystonia, STN seems a promising target for stimulation in patients with secondary dystonia. Further studies including a large number of patients, longer follow-up periods, and more homogenous patients are necessary to establish the optimal target for DBS in the management of secondary dystonias.
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Estimulación Encefálica Profunda/métodos , Distonía/terapia , Globo Pálido , Núcleo Subtalámico , Humanos , Resultado del TratamientoRESUMEN
AIM: To investigate the effect of preoperative levodopa responsiveness to clinical outcomes in the first postoperative year, and to evaluate the changes in the postoperative levodopa responsiveness in patients undergoing subthalamic nucleus (STN) deep brain stimulation (DBS). MATERIAL AND METHODS: Forty-nine Parkinson?s Disease (PD) patients undergoing bilateral DBS of the STN were included in this study. Their clinical motor symptoms were assessed preoperatively by UPDRS Part III score in both OFF and ON medication states. Postoperatively, the assessments were obtained in three consecutive conditions. Preoperatively and postoperatively, the percentage difference between these two scores was evaluated as levodopa response. RESULTS: Mean age was 54.6 ± 9 years (27?70). Levodopa response significantly decreased postoperatively by 56% a year. Compared with preoperative med on and postoperative stim on / med on scores, the clinical results of the first year were obtained and an improvement of 25% on the UPDRS 3 score was observed. Compared with preoperative levodopa response and clinical outcomes, better clinical results were obtained in patients with higher preoperative levodopa response (p < 0.05). CONCLUSION: In this study, we confirm that the response of L-dopa decreases after DBS of the STN. The reasons for this finding are not clear. However, DBS of the STN allows for the reduction of PD medications and improvement of daily life activities, motor function, motor fluctuations, and dyskinesia.
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Antiparkinsonianos/uso terapéutico , Estimulación Encefálica Profunda/tendencias , Levodopa/uso terapéutico , Enfermedad de Parkinson/terapia , Cuidados Posoperatorios/tendencias , Núcleo Subtalámico/fisiología , Adulto , Anciano , Antiparkinsonianos/farmacología , Estimulación Encefálica Profunda/métodos , Femenino , Estudios de Seguimiento , Humanos , Levodopa/farmacología , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/fisiopatología , Cuidados Posoperatorios/métodos , Núcleo Subtalámico/efectos de los fármacos , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIM: To investigate the effect of using microelectrode recording (MER) on the length of time required to carry out a deep brain stimulation (DBS) procedure of the subthalamic nucleus in patients with Parkinson's disease (PD). MATERIAL AND METHODS: The time required to include MER in the DBS operation was calculated for the first and second sides in 24 patients with PD. The number of microelectrodes used on each trajectory for the first and second sides, and the percentage of permanent electrodes implanted on each trajectory for the first and second sides, were quantified. RESULTS: The average times taken to use MER were 23.4 ± 6.2 minutes, 17.4 ± 6.5 minutes, and 41.2 ± 6.3 minutes for the first side, second side and total procedure, respectively. In 75% of patients, the permanent electrode was implanted at the planned target site for the first side, and in 61% of patients for the second side. CONCLUSION: MER extends the time required to carry out the DBS procedure. However, during surgery, it provides real-time information on the electrodes' neurophysiological locations and helps the surgical team choose an alternative target if the planned target does not produce satisfying results.
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Estimulación Encefálica Profunda/métodos , Monitorización Neurofisiológica Intraoperatoria/métodos , Enfermedad de Parkinson/cirugía , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Microelectrodos , Persona de Mediana Edad , Estudios Prospectivos , Núcleo Subtalámico/fisiología , Factores de TiempoRESUMEN
OBJECTIVE: Subthalamic nucleus (STN) is the most targeted localization in the treatment of Parkinson disease (PD) with deep brain stimulation. However, no studies have been found in the literature about possible shape changes of STN in the literature. We aimed to investigate possible shape changes in the STN and the relationship between shape changes and disease duration in PD patients by using statistical analysis. METHODS: Patients who were diagnosed with idiopathic PD and controls were enrolled in this study. Age, sex, and disease duration of all cases were recorded. Turbo-spin-echo T2-weighted axial series parallel to the skull base in each case containing midbrain images were obtained, including the whole STN. Standard anatomic landmarks were selected and marked on each digital image using a special software in all cases. Statistical geometric shape and deformation analysis of STN was performed in 2 groups. RESULTS: Forty-three patients with PD and 50 age/sex-matched controls were enrolled in this study. There were statistically significant left and right STN shape differences between the groups. Maximum deformation was seen in the dorsolateral parts of both STNs. General shape variability of the STNs was found on the left (0.096) and right (0.049). CONCLUSIONS: Significant shape differences and remarkable deformation of STN are seen in patients with PD compared with controls. Maximum deformation was observed in the dorsolateral part of the STN, and with the increase in the duration of the PD, shape differences and deformations became more prominent.
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Imagen por Resonancia Magnética , Enfermedad de Parkinson/diagnóstico por imagen , Núcleo Subtalámico/diagnóstico por imagen , Anciano , Mapeo Encefálico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los ÓrganosRESUMEN
AIM: To investigate microelectrode recording (MER)-induced microlesion effect (MLE) on the motor symptoms of 30 patients with Parkinsonâ™s disease (PD) who underwent deep brain stimulation of the subthalamic nucleus. MATERIAL AND METHODS: MER-induced MLE was evaluated based on the difference between tremor, rigidity, and bradykinesia scores in the preoperative off-state and intraoperative state following MER and before test stimulation. RESULTS: MLE scores improved by 21.7% [left (L) side] and by 13.6% [right (R) side] from baseline (p < 0.05). Tremor scores improved by 31.5% (L) and by 14.2% (R) (p < 0.05), rigidity scores improved by 17.3% (L) and by 14.2% (R) (p < 0.05) and bradykinesia scores improved by 20.6% (L) and by 11.5% (R) (p < 0.05) from baseline. There was no significant difference between MLE and the number of microelectrodes used (p > 0.05). CONCLUSION: MER-induced MLE improved motor symptoms and was not correlated with the number of microelectrodes used during the procedure.
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Estimulación Encefálica Profunda/instrumentación , Monitorización Neurofisiológica Intraoperatoria/instrumentación , Trastornos de la Destreza Motora/cirugía , Enfermedad de Parkinson/cirugía , Núcleo Subtalámico/cirugía , Adulto , Anciano , Estimulación Encefálica Profunda/efectos adversos , Estimulación Encefálica Profunda/métodos , Femenino , Humanos , Monitorización Neurofisiológica Intraoperatoria/efectos adversos , Monitorización Neurofisiológica Intraoperatoria/métodos , Masculino , Microelectrodos/efectos adversos , Persona de Mediana Edad , Trastornos de la Destreza Motora/diagnóstico por imagen , Enfermedad de Parkinson/diagnóstico por imagen , Núcleo Subtalámico/diagnóstico por imagenRESUMEN
BACKGROUND: Frame mounting is considered one of the most critical steps in stereotactic neurosurgery. In routine clinical practice, the aim is to mount the frame as symmetrical as possible, parallel to Reid's line. However, sometimes, the frame is mounted asymmetrically often due to patient-related reasons. METHODS: In this study, we addressed the question whether an asymmetrically mounted frame influences the accuracy of stereotactic electrode implantation. A Citrullus lanatus was used for this study. After a magnetic resonance imaging scan, symmetric and asymmetric mounting of the frame, which could occur in clinical scenarios, was performed with computed tomography (CT). Three different stereotactic software packages were used to analyze the results. In addition, manual calculations were performed by two different observers. RESULTS: Our results show that an asymmetrically mounted frame (deviated, tilted, or rotated) does not affect the accuracy in the mediolateral axis (X-coordinate) or the anteroposterior axis (Y-coordinate). However, it can lead to a clinically relevant error in the superoinferior axis (Z-coordinate). This error was largest with manual calculations. CONCLUSION: These results suggest that asymmetrical frame mounting can lead to stereotactic inaccuracy in the superoinferior axis (Z coordinate).
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AIM: Deep brain stimulation (DBS) surgeries are multi-faceted and the various steps are interconnected. Since its first implementation, the method of DBS surgery has undergone changes. We have encountered several expected and also non-expected perioperative technical complications in the past seventeen years. Here, we describe the stereotactic frame, stereotactic localizer and planning station related complications and how we have managed them as much as possible. MATERIAL AND METHODS: This study is a retrospective qualitative analysis of the documented technical events encountered during DBS surgeries from 1999 onwards. We have collected these events from a cohort of approximately 921 DBS electrodes implantations from the centers of the authors. RESULTS: Stereotactic frame related complications included movement related fixation problems, head anatomy related problems, and lack of maintenance related issues. Localizer related complications were compatibility issues of the stereotactic localizer and planning station, field of view effect on fiducials, air bubbles in localizers using liquid solutions, and disengaged localizer effect. Planning station related complications included image fusion failures and cerebrospinal fluid signal effect on image fusion. CONCLUSION: The road to success in DBS therapy passes through the ability to cope with surgical and technical complications. Each step is unconditionally connected to the other, and detection of the problems that can be encountered in advance and preparations for these negative conditions are the key to success for the group responsible for executing the therapy. We are still learning from these events and advance our surgical approaches.
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Estimulación Encefálica Profunda/efectos adversos , Estimulación Encefálica Profunda/métodos , Complicaciones Intraoperatorias/diagnóstico por imagen , Movimiento , Técnicas Estereotáxicas/efectos adversos , Electrodos Implantados/efectos adversos , Humanos , Complicaciones Intraoperatorias/etiología , Masculino , Atención Perioperativa/métodos , Estudios RetrospectivosRESUMEN
AIM: To investigate the costs of treating the infection with antibiotics only with the risk of surgery when unsuccessful versus immediate removal followed by re-implantation in patients with deep brain stimulation (DBS) hardware infection. MATERIAL AND METHODS: We calculated the costs of the different strategies through a standard costing procedure. A decision model has been applied to establish the average treatment cost per patient representative for a clinical setting where both strategies are employed. Subsequently, a sensitivity analysis has been performed to assess the influence of clinical assumptions regarding the effectiveness of antibiotics treatment on average treatment costs. RESULTS: The costs of treating a case of DBS hardware infection with immediate internal pulse generator (IPG) replacement surgery were ?29,301 compared to ?9499 for successful antibiotic treatment. For antibiotic treatment followed by IPG replacement surgery the total costs were ?38,741. Antibiotic treatment alone was successful in 44% (4/9) of the included cases of DBS infection, resulting in average treatment costs per patient of ?25,745. Trying to resolve DBS hardware infections initially with antibiotics reduced treatment costs by 12.1%. CONCLUSION: Treatment with antibiotics with the risk of a later removal when unsuccessful was a more valuable strategy in terms of costs when compared to immediate surgical intervention in cases of hardware-related infections in DBS surgeries.
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Estimulación Encefálica Profunda/instrumentación , Electrodos Implantados/efectos adversos , Infecciones Relacionadas con Prótesis/economía , Infecciones Relacionadas con Prótesis/terapia , Antibacterianos/economía , Antibacterianos/uso terapéutico , Costos y Análisis de Costo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reoperación/economía , RiesgoRESUMEN
AIMS: The goal of this clinical study was to evaluate the capability of intraoperative ultrasonographical examination to demonstrate the sectioning of the transverse carpal ligament during open surgical treatment of carpal tunnel syndrome with limited uni skin incision (mini skin incision technique). METHODS AND MATERIAL: Intraoperative ultrasonography was used in the detection of complete sectioning of the transverse carpal ligament, and sufficient release of median nerve. Thirty-two female cases were operated with the limited uni skin incision technique. Intraoperative ultrasonography showed the sectioned transverse carpal ligament in all cases. RESULTS: We adopted the sonographic examination to check the ligament during surgical intervention. The capability of ultrasonography is sufficient to demonstrate the median nerve and transverse carpal ligament especially when performing limited uni mini skin incision technique for carpal tunnel surgery. CONCLUSIONS: We suggest the use of ultrasonography for intraoperative checking of the sectioning of the transverse carpal ligament during the surgical treatment of carpal tunnel syndrome with limited uni skin incision.
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Síndrome del Túnel Carpiano/diagnóstico por imagen , Síndrome del Túnel Carpiano/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Monitoreo Intraoperatorio/métodos , Ultrasonografía/métodos , Femenino , Humanos , Ligamentos/diagnóstico por imagen , Ligamentos/cirugía , Nervio Mediano/diagnóstico por imagen , Nervio Mediano/cirugía , Monitoreo Intraoperatorio/instrumentación , Ultrasonografía/instrumentaciónRESUMEN
BACKGROUND: To report our experience of infections in deep brain stimulation (DBS) surgeries comparing shaving versus no shaving of cranial hair. Nonshaving is strongly preferred by patients due to aesthetic and psychological factors. METHODS: This study is a prospective follow-up of the infection rate in 43 nonshaven DBS cases between April 2014 and December 2015 compared to our former infection rate with shaving in our center. Minimum follow-up was 6 months. All patients, except 7 epilepsy patients, received implantation of the electrodes together with the extension cables and internal pulse generator in one session. RESULTS: In 43 nonshaven patients, a total of 81 electrodes were implanted or revised with a mean follow-up of 16 months. One patient (2.32%) developed an infection of the implanted DBS-hardware and was treated with antibiotics. CONCLUSION: In our experience nonshaving of cranial hair in DBS surgery does not lead to more infections when compared to shaving. We have changed our protocol to nonshaving based on these findings.
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BACKGROUND: Deep brain stimulation (DBS) has become a preferred option for the treatment of motor symptoms in patients with advanced Parkinson's disease (PD). A good levodopa response (LR) is considered the most important criterion in determining the suitability of a patient for DBS. However, the effect of age and disease duration (DD) on the LR is still a subject of discussion. OBJECTIVE: Here, we investigated the effect of age and DD on the preoperative LR in PD patients to be selected for DBS. METHODS: From August 2011 to May 2015, 54 consecutive patients (29 men and 25 women) with advanced PD were evaluated for DBS of the STN and included in this retrospective study. RESULTS: Thirty-seven patients were found suitable for DBS of the STN and 29 of them underwent bilateral surgery. We found no significant correlation between DD and the LR. However, there was a significant negative correlation between the patients' age and the LR. CONCLUSION: The results indicate that the patients' age, rather than DD, has a negative effect on the LR. The study, therefore, indicates that PD patients with an advanced age and with a poor LR are not good candidates for DBS of the STN.