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1.
Handb Clin Neurol ; 160: 67-81, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277877

RESUMO

Since the purpose of clinical neurophysiology testing is to record the electrical activity of the nervous system, and often to electrically stimulate the peripheral or central nervous system (for evoked potentials, nerve conduction studies, etc.), these tests by their very nature demand an excellent electrical connection to the patient. This direct electrical connection by definition puts the patient at increased risk of electrical shock. When patients suffer from other nonneurological disorders that also require equipment to be attached to or inserted into their body, the additional and more direct electrical pathways to the heart make them even more vulnerable, especially when undergoing monitoring in the operating room or intensive care unit. Although we depend on the hospital's construction and utilities to follow appropriate regulations (the National Electrical Code in the United States) and on the vendors to sell only safe equipment (approved by the Food and Drug Administration in the United States), there may exist combinations of equipment and connections that put the patient at risk of injurious or fatal electrical shock. Regular testing and safe practices, informed by a scientific understanding of the risks, are the responsibilities of the healthcare providers in order to protect the patient from harm from electricity.


Assuntos
Traumatismos por Eletricidade/prevenção & controle , Terapia por Estimulação Elétrica/efeitos adversos , Monitorização Fisiológica/efeitos adversos , Segurança do Paciente , Traumatismos por Eletricidade/etiologia , Terapia por Estimulação Elétrica/normas , Eletricidade/efeitos adversos , Eletrodos Implantados/efeitos adversos , Humanos , Monitorização Fisiológica/normas , Condução Nervosa/fisiologia , Segurança do Paciente/normas
2.
Pain Res Manag ; 2019: 1236430, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31281554

RESUMO

Background: Spinal cord stimulation is an established treatment option for certain chronic pain conditions which have been previously unresponsive to conservative therapies or potentially for a subset of patients who have not improved following spine surgery. Prior to permanent lead implantation, stimulator lead trials are performed to ensure adequate patient benefit. During these trials, one of the most common complications and reasons for failure is the displacement and migration of the trial leads, resulting in lost therapeutic coverage. Other complications include infection and dislodged bulky dressings. There is a paucity of literature describing an adequate procedural method to prevent these common complications. Objective: This study utilizes a series of 19 patients to evaluate a new technique for securing percutaneous spinal cord simulator trial leads, which may minimize dislodgement and migration complications and improve the rate of trial success. Study Design: Retrospective case series. Setting: New Jersey Medical School, Department of Anesthesiology, Pain Management Division. Methods: A retrospective chart review was conducted on 19 consecutive patients undergoing placement of the percutaneous thoracic spinal cord stimulator trial leads for pain associated with lumbar spine pathology over a two-year period (2010-2012). Results: Of the 19 patients in our cohort, there was one trial lead displacement, no lead migrations, and no site infections. Thirteen patients went on to permanent lead implantation. This improved trial lead placement technique had a high success rate with a low number of complications. Limitations: Small sample size, retrospective case series, and no control group for comparison. Conclusion: This case series was able to demonstrate that our described novel spinal cord stimulator trial lead placement and dressing technique can decrease the incidence of lead displacement and migration, thus improving trial success.


Assuntos
Eletrodos Implantados/efeitos adversos , Migração de Corpo Estranho/prevenção & controle , Procedimentos Neurocirúrgicos/métodos , Estimulação da Medula Espinal/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Estudos Retrospectivos
3.
World Neurosurg ; 130: e839-e845, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295613

RESUMO

BACKGROUND: Risk factors for infection after vagus nerve stimulation (VNS) device implantation represent an important issue but remain unclear. We hypothesized that specific risk factors for infection would be associated with VNS device implantation. This study reviewed patients with epilepsy who underwent VNS device implantation and undertook a statistical analysis of risk factors for surgical site infection (SSI). METHODS: We reviewed all medical records for patients who underwent VNS therapy in our facility between August 2011 and May 2018. Age, sex, height, body weight, body mass index (BMI), intelligence quotient (IQ), surgical incision opening time, blood loss, epilepsy classification, activities of daily living, and generator replacement were statistically compared between cases with and without SSI. RESULTS: We performed 208 VNS device implantation surgeries at our facility during the study period. Among these, 150 patients underwent initial implantation, 56 patients underwent first generator replacement, and 2 patients underwent second replacement. Six patients (2.7%) with initial implantation and 3 patients (5.4%) with first replacement showed SSI. Low BMI was a risk factor for infection at initial implantation (P < 0.0012) using a BMI within 1.78 kg/m2 of the cutoff for being underweight (100% sensitivity, 25% specificity). Low IQ (P = 0.0015) was also a risk factor for SSI. CONCLUSIONS: This study identified low BMI and low IQ at initial implantation as risk factors for infection.


Assuntos
Índice de Massa Corporal , Eletrodos Implantados/efeitos adversos , Inteligência , Infecção da Ferida Cirúrgica/diagnóstico , Estimulação do Nervo Vago/efeitos adversos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Seguimentos , Humanos , Lactente , Inteligência/fisiologia , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento , Estimulação do Nervo Vago/instrumentação , Adulto Jovem
4.
No Shinkei Geka ; 47(7): 785-791, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31358698

RESUMO

We report a rare complication in a patient with Parkinson's disease who underwent deep brain stimulation(DBS)surgery. The patient was a 60-year-old woman who presented with frontal lobe signs, including ataxic gait and memory disturbance, that were caused by the unexpected migration of a burr hole cap into the brain three to four months after surgery. The patient had no incidence of a head injury prior to development of symptoms. The patient underwent surgery to extract the migrated cap from the frontal lobe, and her symptoms improved several months after the operation. The cap serves to fix the DBS lead to the skull using an adjunctive burr hole ring. It was intraoperatively confirmed that only the cap detached from the ring, and no cap or ring defects were detected in a postoperative quality check by the manufacturer. We have previously utilized a burr hole ring and cap, which are packaged along with the DBS electrode, when employing the product made by Medtronic Inc. No previous report has described the cap packed in the official DBS kit to have migrated into the intracranial space. It seems unlikely that the cap migration into the intracranial space would occur without the cap and/or ring breaking through either traumatic injury or from manufacturing defects. It is important to consider the migration of a burr hole cap into the intracranial space in the absence of head injury as a possible device complication after DBS surgery.


Assuntos
Estimulação Encefálica Profunda , Eletrodos Implantados , Lobo Frontal , Doença de Parkinson/terapia , Encéfalo , Estimulação Encefálica Profunda/efeitos adversos , Eletrodos Implantados/efeitos adversos , Feminino , Lobo Frontal/patologia , Humanos , Pessoa de Meia-Idade , Trepanação
5.
World Neurosurg ; 129: 85-89, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31158542

RESUMO

BACKGROUND: Glioblastoma (GBM) is the most common aggressive malignant primary brain tumor, rarely concurrent in patients who require deep brain stimulation (DBS) implants. Despite the high incidence of these circumstances alone, the coexistence of both in a patient has been seldom reported. In this paper, we report a case of a patient suffering from a movement disorder treated with DBS who developed a GBM. CASE DESCRIPTION: A patient with bilateral DBS of the globus pallidus internus for refractory secondary dystonia developed a GBM close to the electrode leads, 2.5 years after implantation. The clinical findings, medical management and pitfalls, and possible relationship between the DBS device and the tumor development are discussed. We withdrew the system to perform brain magnetic resonance imaging safely. This revealed an extended lesion that was biopsied. The removal led to a clinical worsening that resulted in fatality, without the possibility of receiving adjuvant treatment. The available literature shows similar management, which depends mainly on the stimulation system used. CONCLUSIONS: We advise the use of magnetic resonance imaging-safe devices; otherwise, we recommend keeping the system and proceeding with computed tomography imaging for diagnostic and management if necessary. The true relationship between chronic DBS stimulation and GBM is to be clarified.


Assuntos
Neoplasias Encefálicas/patologia , Estimulação Encefálica Profunda , Glioma/patologia , Distonia/terapia , Eletrodos Implantados/efeitos adversos , Evolução Fatal , Feminino , Globo Pálido/patologia , Humanos , Pessoa de Meia-Idade
6.
Bioelectrochemistry ; 129: 79-89, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31125924

RESUMO

When implantable recording devices for brain or neural electrical activity are designed, the number of available materials for electrodes is quite limited. The material must be biocompatible with respect to ISO10993, its electrochemical properties must remain stable and the response of cells or tissues can be mitigated, especially on the glial scar. This involves electrode characterization pre- implantation and impedance spectroscopy during chronic implantation, in order to evaluate both electrode properties and performance. This study was aimed at a comparison of the long-term behavior of a nanostructured boron-doped diamond (BDD) with a nanostructured Platinum Iridium (PtIr) electrode. Firstly, a batch of cortical grids with bare and modified contacts (2 mm in diameter) was engineered for implantation. Secondly a miniature swine model was developed. This study highlighted the predominant role of electrode surface roughness on the quality of recordings. Rough PtIr contacts and BDD coated ones showed comparable behavior after three-month implantation with a slight increase of the modulus of the impedance and a tissue capsule. Nevertheless, immunohistochemistry analysis did not exhibit either a toxic or irritation reaction. With regard to biocompatibility, promising long term results are shown for both materials.


Assuntos
Materiais Biocompatíveis/química , Boro/química , Diamante/química , Eletrodos Implantados , Nanoestruturas/química , Animais , Materiais Biocompatíveis/efeitos adversos , Boro/efeitos adversos , Encéfalo/ultraestrutura , Diamante/efeitos adversos , Espectroscopia Dielétrica , Técnicas Eletroquímicas , Eletrodos Implantados/efeitos adversos , Proteína Glial Fibrilar Ácida/análise , Nanoestruturas/efeitos adversos , Nanoestruturas/ultraestrutura , Suínos , Porco Miniatura
7.
Brain Stimul ; 12(5): 1111-1120, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31031208

RESUMO

BACKGROUND: Data on pediatric DBS is still limited because of small numbers in single center series and lack of systematic multi-center trials. OBJECTIVES: We evaluate short- and long-term adverse events (AEs) of patients undergoing deep brain stimulation (DBS) during childhood and adolescence. METHODS: Data collected by the German registry on pediatric DBS (GEPESTIM) were analyzed according to reversible and irreversible AEs and time of occurrence with relation to DBS-surgery: Intraoperative, perioperative (<4 weeks), postoperative (4 weeks < 6 months) and long term AEs (>6 months). RESULTS: 72 patients with childhood-onset dystonia from 10 DBS-centers, who received 173 DBS electrodes and 141 implantable pulse generators (IPG), were included in the registry. Mean time of postoperative follow-up was 4.6 ±â€¯4 years. In total, 184 AEs were documented in 53 patients (73.6%). 52 DBS-related AEs in 26 patients (36.1%) required 45 subsequent surgical interventions 4.7 ±â€¯4.1 years (range 3 months-15 years) after initial implantation. The total risk of an AE requiring surgical intervention was 7.9% per electrode-year. Hardware-related AEs were the most common reason for surgery. There was a tendency of a higher rate of AEs in patients aged 7-9 years beyond 6 months after implantation. DISCUSSION: The intraoperative risk of AEs in pediatric patients with dystonia undergoing DBS is very low, whereas the rate of postoperative hardware-related AEs is a prominent feature with a higher occurrence compared to adults, especially on long-term follow-up. CONCLUSION: Factors leading to such AEs must be identified and patient management has to be focused on risk minimization strategies in order to improve DBS therapy and maximize outcome in pediatric patients.


Assuntos
Estimulação Encefálica Profunda/efeitos adversos , Distúrbios Distônicos/epidemiologia , Distúrbios Distônicos/terapia , Eletrodos Implantados/efeitos adversos , Adolescente , Criança , Distúrbios Distônicos/diagnóstico , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Masculino , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/epidemiologia
8.
Heart Surg Forum ; 22(2): E131-E133, 2019 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-31013223

RESUMO

BACKGROUND: Pacemaker lead-related thrombosis is a rare but severe complication in patients with pacing lead implantation in the right ventricle. We present a case with recurrent syncope after single-chamber implantable cardioverter defibrillator (ICD) implantation. Pacing lead-related thrombosis was observed during open-heart surgery. This induced intermittent pacemaker dysfunction and recurrent syncope. CASE PRESENTATION: A 67-year-old male patient presented with frequent episodes of syncope and a history of dilated cardiomyopathy and paroxysmal ventricular tachycardia. Normal coronary angiography was found, and therefore a single-chamber ICD was implanted into the right ventricle to prevent cardiac events in 2013. However, he was referred to our hospital because of recurrent syncope 3 to 4 years after ICD implantation. A comprehensive investigation was performed to find out the etiology for the recurrent syncope. Pacing lead thrombosis was finally observed during open-heart surgery, which can introduce intermittent pacemaker dysfunction. After the thrombus was removed and the lead was separated from the posterior leaflet of the tricuspid valve, the ICD functioned normally after reprogramming. Oral anticoagulant was prescribed after discharging. During the 1-year follow-up period, this patient was free of syncope. CONCLUSIONS: This case illustrated that pacemaker lead-associated thrombosis should be considered when the cardiac implantable electronic device fails to prevent patients from having cardiac events. Oral anticoagulant might be important for preventing thrombosis among patients with ICD implantation into the right ventricle.


Assuntos
Trombose Coronária/etiologia , Trombose Coronária/cirurgia , Eletrodos Implantados/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Síncope/etiologia , Idoso , Eletrocardiografia , Ventrículos do Coração , Humanos , Masculino , Falha de Prótese , Recidiva
9.
PLoS One ; 14(4): e0215589, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31034499

RESUMO

INTRODUCTION: Cardiac implantable electronic device (CIED) trans venous lead extraction (TLE) is technically challenging. Whether the use of a laser sheath reduces complications and improves outcomes is still in debate. We therefore aimed at comparing our experience with and without laser in a large referral center. METHODS: Information of all patients undergoing TLE was collected prospectively. We retrospectively compared procedural outcomes prior to the introduction of the laser sheath lead extraction technique to use of laser sheath. RESULTS: During the years 2007-2017, there were 850 attempted lead removals in 407 pts. Of them, 339 (83%) were extracted due to infection, device upgrade/lead malfunction in 42 (10%) cases, and other (7%). Complete removal (radiological success) of all leads was achieved in (88%). Partial removal was achieved in another 6% of the patients. Comparison of cases prior to and after laser technique introduction, showed that with laser, a significantly smaller proportion of cases required conversion to femoral approach [31/275 (6%) laser vs. 40/132 (15%) non-laser; p<0.001]. However, success rates of removal [259/275 (94%) vs. 124/132 (94%) respectively; p = 0.83] and total complication rates [35 (13%) vs. 19 (14%) respectively; p = 0.86] did not differ prior to and after laser use. In multivariate analysis, laser-assisted extraction was an independent predictor for no need for femoral extraction (OR = 0.39; 95% CI 0.23-0.69; p = 0.01). CONCLUSION: Introduction of laser lead removal resulted in decreased need to convert to femoral approach, albeit without improving success rates or preventing major complications.


Assuntos
Remoção de Dispositivo/métodos , Eletrodos Implantados , Marca-Passo Artificial , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/instrumentação , Eletrodos Implantados/efeitos adversos , Falha de Equipamento , Feminino , Veia Femoral , Humanos , Lasers , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Estudos Prospectivos , Veia Subclávia/lesões , Resultado do Tratamento
11.
PET Clin ; 14(2): 251-269, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30826023

RESUMO

The 2015 European Society of Cardiology guidelines for the management of infective endocarditis included 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in the diagnostic work-up of prosthetic valve endocarditis. This article examines the literature from the last 3 years to highlight the additional role 18F-FDG-PET/CT can contribute to an accurate diagnosis of cardiac infections and associated infectious complications. The challenges and pitfalls associated with 18F-FDG-PET/CT in such clinical settings must be recognized and these are discussed along with the suggested protocols that may be incorporated in an attempt to address these issues.


Assuntos
Endocardite/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Antibacterianos/uso terapêutico , Eletrodos Implantados/efeitos adversos , Endocardite/tratamento farmacológico , Reações Falso-Negativas , Fluordesoxiglucose F18 , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Coração Auxiliar/efeitos adversos , Humanos , Interpretação de Imagem Assistida por Computador , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/tratamento farmacológico , Compostos Radiofarmacêuticos
12.
Neuromodulation ; 22(4): 456-464, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30844131

RESUMO

OBJECTIVE: Although deep brain stimulation (DBS) is an effective treatment for movement disorders, improvement varies substantially in individuals, across clinical trials, and over time. Noninvasive biomarkers that predict the individual response to DBS could be used to optimize outcomes and drive technological innovation in neuromodulation. We sought to evaluate whether noninvasive event related potentials elicited by subthalamic DBS during surgical targeting predict the tolerability of a given stimulation site in patients with advanced Parkinson's disease. METHODS: Using electroencephalography, we measured event related potentials elicited by 20 Hz DBS over a range of stimulus intensities across the spatial extent of the implanted electrode array in 11 patients. We correlated event related potential timing and morphology with the stimulus amplitude thresholds for motor side effects during postoperative programming at ≥130 Hz. RESULTS: During surgical targeting, DBS at 20 Hz elicits large amplitude, high frequency activity (evoked HFA) with mean onset latency of 9.0 ± 0.3 msec and a mean frequency of 175.8 ± 7.8 Hz. The lowest DBS amplitude that elicits the HFA predicts thresholds for motor side effects during postoperative stimulation at ≥130 Hz (p < 0.001, ANOVA). CONCLUSION: Event related potentials elicited by DBS can predict clinically relevant corticospinal activation by stimulation after surgery. Noninvasive scalp physiology requires no patient interaction and could serve as a biomarker to guide targeting, postoperative programming, and emerging technologies such as directional and closed-loop stimulation.


Assuntos
Estimulação Encefálica Profunda/efeitos adversos , Potencial Evocado Motor/fisiologia , Córtex Motor/fisiologia , Doença de Parkinson/cirurgia , Complicações Pós-Operatórias/diagnóstico , Núcleo Subtalâmico/fisiologia , Idoso , Estimulação Encefálica Profunda/tendências , Eletrodos Implantados/efeitos adversos , Eletrodos Implantados/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes
14.
Female Pelvic Med Reconstr Surg ; 25(2): e45-e46, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30730349

RESUMO

OBJECTIVE: Neurologic injury after sacral nerve stimulation (SNS) is rare, but the incidence is unknown. Infection is a potential mechanism for neurologic damage. This report illustrates the presentation, pathophysiology, diagnostic considerations, and treatment of epidural infection causing neurologic deficits after SNS. CASE REPORT: We present a case of a woman with severe fecal incontinence due to Crohn's disease who underwent SNS implantation and subsequently developed a wound infection requiring complete device explantation. A few days later, she presented with leg pain and weakness. Urgent evaluation and treatment of epidural infection were performed. She had persistent neurologic deficits 6 months later. CONCLUSIONS: Neurologic sequelae from an infection after SNS are a rare event and should be considered in patients with fevers, leg pain, and neurologic deficits.


Assuntos
Eletrodos Implantados/efeitos adversos , Abscesso Epidural/diagnóstico , Abscesso Epidural/etiologia , Plexo Lombossacral , Infecção da Ferida Cirúrgica/complicações , Adulto , Remoção de Dispositivo , Terapia por Estimulação Elétrica , Abscesso Epidural/tratamento farmacológico , Incontinência Fecal/terapia , Feminino , Humanos , Debilidade Muscular/microbiologia , Polirradiculopatia/microbiologia
15.
Turk Neurosurg ; 29(4): 611-614, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30649801

RESUMO

The true incidence of hemorrhagic venous infarctions in deep brain stimulation (DBS) procedures is very difficult to determine. These hemorrhagic venous complications are very rare and often grouped as all hemorrhagic complications. We report the clinical cases of 2 patients with Parkinson's disease (PD) who received unilateral globus pallidus DBS and developed hemorrhagic venous infarctions. In these 2 patients a small injury to a dural outflow venous structure or a superficial brain vein resulted in hemorrhagic venous infarctions. We present the management of these rare complication with detailed radiologic follow-up. The first patient made a full recovery but the second patient deceased 5 months after DBS surgery due to aspiration pneumonia. We stress that careful planning of a stereotactic trajectory reduces significantly hemorrhagic complications in DBS surgery but not fully exclude some side effects like venous hemorrhagic infarctions which may result in prolong hospitalization or death.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Veias Cerebrais/diagnóstico por imagem , Estimulação Encefálica Profunda/efeitos adversos , Eletrodos Implantados/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Hemorragia Cerebral/etiologia , Infarto Cerebral/etiologia , Estimulação Encefálica Profunda/métodos , Feminino , Globo Pálido/diagnóstico por imagem , Globo Pálido/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/cirurgia , Complicações Pós-Operatórias/etiologia
17.
J Clin Neurosci ; 59: 347-349, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30470653

RESUMO

The incidence of symptomatic percutaneous intrathecal subarachnoid lead placement for spinal cord stimulator is almost an unheard of complication in the literature. We present the first case of a spinal cord stimulator implant with a complication of symptomatic intrathecal subarachnoid lead placement with a pseudomeningocele. This complication was found with myelogram and addressed by replacement with a new spinal cord stimulator implant with paddle leads instead of percutaneous leads and obliterating the pseudomeningocele tract. Technique for epidural lead placement is discussed. This case illustrates a spinal cord stimulator implant complication of intrathecal percutaneous lead placement with pseudomeningocele and its recognition and treatment involving replacement of the system while minimizing risk of postoperative cerebrospinal fluid leakage. Intraoperative neuromonitoring and interrogation of the spinal cord stimulator system during implantation are effective tools for accurate epidural lead placement.


Assuntos
Terapia por Estimulação Elétrica/efeitos adversos , Eletrodos Implantados/efeitos adversos , Espaço Epidural/cirurgia , Complicações Pós-Operatórias/etiologia , Medula Espinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
18.
J Clin Neurosci ; 59: 29-31, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30472347

RESUMO

Peri-electrode edema can occur after deep brain stimulation (DBS). The diagnosis and management of peri-electrode edema may be challenging. We herein report non-infectious peri-electrode edema after the placement of DBS electrodes in patients with Parkinson's disease (PD). Fifteen patients who underwent DBS surgery between 2010 and 2018 at Sapporo Medical University were included to identify post-operative peri-electrode edema. Pre- and post-operative CT and MRI were retrospectively analyzed. Six patients showed hyperintensity around the electrodes on FLAIR/T2 MRI without neurological deficits. Two patients showed limited FLAIR and DWI hyperintensities in deep white matter, and microvessels may have been occluded in these patients. In five patients, MRI revealed extensive FLAIR or T2 hyperintensity in surface white matter around the electrodes without vessel injury, whereas DWI showed no abnormal signals. The eosinophil count was increased in one of these five patients. Peri-electrode edema after DBS surgery is not an uncommon phenomenon, and includes two types: (1) limited edema in deep white matter and (2) extensive edema in surface white matter. Different mechanisms may be associated with these types of edemas.


Assuntos
Estimulação Encefálica Profunda/efeitos adversos , Edema/etiologia , Eletrodos Implantados/efeitos adversos , Doença de Parkinson/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
J Interv Card Electrophysiol ; 54(2): 161-170, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30471050

RESUMO

PURPOSE: To compare lead failure manifestation and lead performance of the Biotronik Linox/Sorin Vigila defibrillator lead (Linox group) with the St. Jude Medical Riata/Riata ST (Riata group) and Medtronic Sprint Fidelis defibrillator leads (Fidelis group). METHODS: We assessed the performance of all aforementioned leads implanted at our center and investigated the manifestation of lead failures. RESULTS: Of 93 Linox, 86 Riata, and 81 Fidelis leads implanted at our center, 11 (12%), 22 (26%), and 25 (31%) leads failed during a median follow-up of 46, 61, and 84 months, respectively. Inappropriate shocks were delivered in 64% (Linox), 5% (Riata), and 32% (Fidelis) of lead failures; a device alert was noted in none (Linox), 5% (Riata), and 52% (Fidelis); and lead failure was a coincidental finding in 36% (Linox), 91% (Riata), and 16% (Fidelis) of cases (p < 0.001). Non-physiological high rate signals were observed in 73% (Linox), 27% (Riata), and 80% (Fidelis) of lead failures (p = 0.001) and damaged lead integrity was found in 36% (Linox), 73% (Riata), and 24% (Fidelis) of cases (p = 0.064). Lead survival at 5 years was 88%, 92%, and 71% for Linox, Riata, and Fidelis group, respectively. CONCLUSIONS: The most frequent clinical manifestation of lead failure was inappropriate shocks for Linox, coincidental finding for Riata and device alert for Fidelis leads. Non-physiological high rate signals were frequently observed in Linox and Fidelis lead failures whereas in Riata lead failures, a damaged lead integrity was the predominant finding.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Eletrodos Implantados/efeitos adversos , Desenho de Equipamento/métodos , Análise de Falha de Equipamento , Segurança de Equipamentos/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/métodos , Cardiomiopatia Dilatada/terapia , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/terapia , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Estados Unidos
20.
Eur J Neurol ; 26(3): 533-539, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30358915

RESUMO

BACKGROUND AND PURPOSE: The aim of this study was to define the prevalence and characteristics of peri-electrode edema in a prospective cohort of patients undergoing deep brain stimulation (DBS) surgery and to correlate it with clinical findings. METHODS: We performed brain magnetic resonance imaging (MRI) between 7 and 20 days after surgery in 19 consecutive patients undergoing DBS surgery for Parkinson's disease. The T2-weighted hyperintensity surrounding DBS leads was characterized and quantified. Any evidence of bleeding around the leads was also evaluated. Clinical and follow-up data were recorded. In a subgroup of patients, a follow-up MRI was performed 3-6 weeks after surgery. We also retrospectively reviewed the post-operative computed tomography scans of patients who underwent DBS at our center since 2013. RESULTS: Magnetic resonance imaging showed a peri-lead edematous reaction in all (100%) patients, which was unilateral in three patients (15.8%). In six patients (31.6%), we detected minor peri-lead hemorrhage. Edema completely resolved in eight out of 11 patients with a follow-up MRI and was markedly reduced in the others. Most patients were asymptomatic but six (31.6%) manifested various degrees of confusional state without motor symptoms. We found no significant correlation between edema volume, distribution and any clinical feature, including new post-operative neurological symptoms. The retrospective computed tomography analysis showed that peri-electrode hypodensity consistent with edema is absent at early post-operative imaging but is common at scans performed >3 days after surgery. CONCLUSIONS: Peri-electrode edema is a common, transient reaction to DBS lead placement and a convincing relation between edema and post-operative clinical status is lacking.


Assuntos
Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Estimulação Encefálica Profunda/efeitos adversos , Eletrodos Implantados/efeitos adversos , Imagem por Ressonância Magnética/métodos , Doença de Parkinson/terapia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade
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