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1.
Dev Med Child Neurol ; 62(1): 28-33, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31211420

RESUMO

Cerebral palsy (CP) is a complex disorder and children frequently have multiple impairments. Dystonia is a particularly frustrating impairment that interferes with rehabilitation and function and is difficult to treat. Of the available treatments, deep brain stimulation (DBS) has emerged as an option with the potential for large effect size in a subgroup of children. While brain stimulation has been used in CP for more than 40 years, modern devices and targeting methods are improving both the safety and efficacy of the procedure. Successful use of DBS depends on appropriate selection of patients, identification of effective neuroanatomical targets in each patient, careful neurosurgical procedure, and detailed follow-up evaluation and programming. The use of functional neurosurgery for neuromodulation in CP remains a technology in its infancy, but improving experience and knowledge are likely to make this one of the safest and most effective interventions for children with moderate-to-severe motor disorders. This review summarizes the current procedures for patient and target selection, and surgical implantation of DBS electrodes for CP. The history of DBS and future directions when used in secondary dystonia are also examined. WHAT THIS PAPER ADDS: Selection of candidates for deep brain stimulation (DBS) requires understanding of dystonia in cerebral palsy . DBS could become a first-line treatment option in some children.


Assuntos
Paralisia Cerebral/terapia , Estimulação Encefálica Profunda , Distonia/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde , Paralisia Cerebral/complicações , Paralisia Cerebral/cirurgia , Criança , Estimulação Encefálica Profunda/efeitos adversos , Estimulação Encefálica Profunda/normas , Estimulação Encefálica Profunda/tendências , Distonia/etiologia , Distonia/cirurgia , Humanos
2.
NeuroRehabilitation ; 45(4): 567-569, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31868700

RESUMO

BACKGROUND: Dystonia is the third common motor disorder; deep brain stimulation (DBS) has been reported as beneficial in selected dystonia patients. OBJECTIVE: To assess the effects of DBS in adults with dystonia. METHODS: Cochrane Review conducted by Rodrigues et al. searching for RCTs with a parallel design, comparing DBS versus placebo, sham intervention, or best medical/surgical treatment was summarized and discussed from a rehabilitation perspective. RESULTS: Only two RCTs, at high risk of bias, and comparing DBS with sham intervention, were selected; low quality evidence was found that DBS may improve specific symptoms and functionality in adults with cervical or segmental/generalized dystonia; no conclusion was reached on DBS safety and tolerability. CONCLUSIONS: High quality studies are needed to verify DBS effects in dystonia; more types of dystonia and other control interventions also need to be addressed.


Assuntos
Estimulação Encefálica Profunda/efeitos adversos , Distúrbios Distônicos/terapia , Adulto , Estimulação Encefálica Profunda/métodos , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Stereotact Funct Neurosurg ; 97(3): 207-211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31600763

RESUMO

The authors describe how severe coughing and breathing issues were caused by a deep brain stimulation (DBS) system due to current induction in the adjacent vagus nerve. A 57-year-old man with Parkinson's disease (PD) who received bilateral subthalamic nucleus DBS presented with coughing and breathing difficulty when his DBS system was activated. The intensity of coughing was directly related to the amount of stimulation. When the DBS system was turned off, his cough resolved immediately. A system check revealed no radiographic abnormalities and all electrode impedances were within the normal range. We hypothesize that the coughing was caused by an induced electromagnetic stimulation of the vagus nerve from the extensions, which were running in close proximity to the nerve in the neck. Since the patient could not tolerate the coughing at stimulation settings required to ameliorate his PD symptoms, we ultimately exchanged the extensions and moved them further away from the vagus nerve. This resulted in immediate, complete, and continuous relief of the patient's symptoms.


Assuntos
Tosse/etiologia , Estimulação Encefálica Profunda/efeitos adversos , Doença de Parkinson/terapia , Estimulação do Nervo Vago/efeitos adversos , Tosse/diagnóstico , Estimulação Encefálica Profunda/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Núcleo Subtalâmico/fisiologia , Nervo Vago/fisiologia
4.
PLoS One ; 14(8): e0220043, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31390346

RESUMO

Patients with deep brain stimulation (DBS) implants can significantly benefit from magnetic resonance imaging (MRI), however access to MRI is restricted in these patients because of safety concerns due to RF heating of the leads. Recently we introduced a patient-adjustable reconfigurable transmit coil for low-SAR imaging of DBS at 1.5T. A previous simulation study demonstrated a substantial reduction in the local SAR around single DBS leads in 9 unilateral lead models. This work reports the first experimental results of temperature measurement at the tips of bilateral DBS leads with realistic trajectories extracted from postoperative CT images of 10 patients (20 leads in total). A total of 200 measurements were performed to record temperature rise at the tips of the leads during 2 minutes of scanning with the coil rotated to cover all accessible rotation angles. In all patients, we were able to find an optimum coil rotation angle and reduced the heating of both left and right leads to a level below the heating produced by the body coil. An average heat reduction of 65% was achieved for bilateral leads. When considering each lead alone, an average heat reduction of 80% was achieved. Our results suggest that reconfigurable coil technology introduces a promising approach for imaging of patients with DBS implants.


Assuntos
Estimulação Encefálica Profunda/efeitos adversos , Estimulação Encefálica Profunda/instrumentação , Temperatura Alta , Imagem por Ressonância Magnética/instrumentação , Próteses e Implantes , Ondas de Rádio , Rotação
5.
J Clin Neurosci ; 69: 241-244, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31431404

RESUMO

BACKGROUND: The goal of deep brain stimulation (DBS) is to achieve maximal benefit for the patient while minimizing the likelihood of adverse effects. Currently, no standardized criteria exist that predicts extended hospital stay in DBS patients, although careful patient selection is recognized as a very important step for successful DBS therapy. OBJECTIVES AND METHODS: The objective of this study was to identify eight key factors that predicted extended post-operative hospital stay following DBS lead implantation, in an effort to better identify patients that would require minimal hospital stay, resulting in reduced cost and reduced exposure to hospital- related problems. Univariate logistic regression models were used to examine associations between each factor and patients' post-surgical outcomes. RESULTS: Using data collected from 183 patients, we found that 53 patients required a hospital stay longer than two days within one month post-procedure. Those who were 70 years or older and those who had frequent falls were significantly more likely to require extended post-surgical care. Patients that scored three points or higher on our eight-factor assessment scale had a greater likelihood of experiencing an event that would require an extended hospital stay following DBS lead placement, regardless of what three factors were present. CONCLUSIONS: Any PD patient who is 70 years or older, incurring frequent falls, or with more than three points on our scale, should be carefully screened and cautioned about likely prolonged recovery and extended post-operative hospital stay.


Assuntos
Estimulação Encefálica Profunda/métodos , Tempo de Internação , Doença de Parkinson/cirurgia , Acidentes por Quedas , Fatores Etários , Idoso , Estimulação Encefálica Profunda/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
6.
J Clin Neurosci ; 69: 88-92, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31445813

RESUMO

Although general risk of deep brain stimulation (DBS) therapy has been previously described, application of risk prediction at the individual patient level is still largely at the discretion of a treating physician or a multidisciplinary team. To explore associations between potentially modifiable patient characteristics and common adverse events following DBS surgery, we retrospectively reviewed consecutive adult patients who had undergone new DBS electrode placement surgeries at two high-volume tertiary referral centers between October 1997 and May 2018. Among 501 patients included in the analysis (mean age (SD), 64.6 (10.4) years), 165 (32.9%) were female, 67 (13.4%) had diabetes, 231 (46.1%) had hypertension, 25 (5.0%) were smokers, 27 (5.4%) developed an infection, 15 (3.0%) had intracranial or intraventricular hemorrhage, and 53 (10.6%) had an unplanned return to the operating room. Patients who developed a surgical site infection were more likely to report history of smoking before DBS surgery (16% vs 5%, p = 0.04). There was a trend for patients with hypertension to be at risk for intracranial hemorrhage (p = 0.11). In conclusion, this multicenter study demonstrated an association between preoperative smoking and increased risk of infection following new DBS implantation surgery. Counseling about this risk should be considered in preoperative evaluation of patients who are considering undergoing a DBS procedure.


Assuntos
Estimulação Encefálica Profunda/efeitos adversos , Fumar/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Adulto , Idoso , Estimulação Encefálica Profunda/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/terapia , Estudos Retrospectivos , Adulto Jovem
7.
World Neurosurg ; 132: 314-320, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31449994

RESUMO

BACKGROUND: Whereas transient, self-limiting seizures are an infrequent but known complication of deep brain stimulation (DBS) implantation surgery, stimulation itself has occasionally been reported to result in seizure activity at delayed time points. The neural circuitry implicated in stimulation-induced seizures is unknown. CASE DESCRIPTION: A 47-year-old woman underwent chronic subcallosal cingulate DBS for treatment of refractory anorexia nervosa and experienced seizure with stimulation onset. Supratherapeutic voltage caused a generalized seizure. The patient subsequently experienced a full recovery. We reviewed the literature for other cases of delayed postoperative DBS seizures associated with stimulation. We also investigated whether the higher voltage may have recruited networks implicated in epilepsy. The supratherapeutic voltage stimulated a larger area and engaged vulnerable networks, including bilateral hippocampi, cingulate gyrus, and temporal lobes. Literature review identified 20 studies reporting delayed seizure after DBS surgery, 13 of which demonstrated a robust association with mostly nonmotor DBS stimulation. CONCLUSIONS: Nonmotor DBS targets, particularly in patients with epilepsy, may be more vulnerable to stimulation-induced seizures; as such, extra caution should be used when programming stimulation parameters at these DBS targets.


Assuntos
Anorexia Nervosa/terapia , Encéfalo/fisiopatologia , Estimulação Encefálica Profunda/efeitos adversos , Convulsões/etiologia , Anticonvulsivantes/uso terapêutico , Encéfalo/diagnóstico por imagem , Feminino , Giro do Cíngulo/diagnóstico por imagem , Giro do Cíngulo/fisiopatologia , Hipocampo/diagnóstico por imagem , Hipocampo/fisiopatologia , Humanos , Lamotrigina/uso terapêutico , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Vias Neurais/diagnóstico por imagem , Vias Neurais/fisiopatologia , Convulsões/diagnóstico por imagem , Convulsões/tratamento farmacológico , Convulsões/fisiopatologia , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/fisiopatologia
8.
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
9.
Stereotact Funct Neurosurg ; 97(2): 101-105, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31280257

RESUMO

BACKGROUND/AIMS: Internal pulse generator (IPG) replacement is considered a relatively minor surgery but exposes the deep brain stimulation system to the risk of infectious and mechanical adverse events. We retrospectively reviewed complications associated with IPG replacement surgery in our center and reviewed the most relevant publications on the issue. METHODS: A retrospective analysis of all the IPG replacements performed in our center from January 2003 until March 2018 was performed. A logistic regression model was used to analyze the risk factors associated with IPG infections at our center. RESULTS: A total of 171 IPG replacements in 93 patients were analyzed. The overall rate of replacement complications was 8.8%, whereas the rate of infection was 5.8%. IPG removal was required in 8 out of 10 infected cases. An increased risk of infection was found in patients with subcutaneous thoracic placement of the IPG (OR 5.3, p = 0.016). The most commonly isolated germ was Staphylococcus coagulase negative (60%). We found a non-significant trend towards increased risk of infection in patients with more than 3 replacements (p = 0.07). CONCLUSIONS: Infection is the most frequent complication related to IPG replacement. Staphylococcus coagulase negative is the most commonly isolated bacteria causing the infection. According to our results, the subcutaneous thoracic placement represents a greater risk of infection compared to subcutaneous abdominal placement.


Assuntos
Estimulação Encefálica Profunda/efeitos adversos , Estimulação Encefálica Profunda/instrumentação , Eletrodos Implantados/efeitos adversos , Neuroestimuladores Implantáveis/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Estimulação Encefálica Profunda/métodos , Tremor Essencial/diagnóstico , Tremor Essencial/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Doença de Parkinson/cirurgia , Estudos Retrospectivos , Fatores de Risco
10.
PLoS One ; 14(6): e0217985, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31216311

RESUMO

OBJECTIVE: Segmented deep brain stimulation leads in the subthalamic nucleus have shown to increase therapeutic window using directional stimulation. However, it is not fully understood how these segmented leads with reduced electrode size modify the volume of tissue activated (VTA) and how this in turn relates with clinically observed therapeutic and side effect currents. Here, we investigated the differences between directional and omnidirectional stimulation and associated VTAs with patient-specific therapeutic and side effect currents for the two stimulation modes. APPROACH: Nine patients with Parkinson's disease underwent DBS implantation in the subthalamic nucleus. Therapeutic and side effect currents were identified intraoperatively with a segmented lead using directional and omnidirectional stimulation (these current thresholds were assessed in a blinded fashion). The electric field around the lead was simulated with a finite-element model for a range of stimulation currents for both stimulation modes. VTAs were estimated from the electric field by numerical differentiation and thresholding. Then for each patient, the VTAs for given therapeutic and side effect currents were projected onto the patient-specific subthalamic nucleus and lead position. RESULTS: Stimulation with segmented leads with reduced electrode size was associated with a significant reduction of VTA and a significant increase of radial distance in the best direction of stimulation. While beneficial effects were associated with activation volumes confined within the anatomical boundaries of the subthalamic nucleus at therapeutic currents, side effects were associated with activation volumes spreading beyond the nucleus' boundaries. SIGNIFICANCE: The clinical benefits of segmented leads are likely to be obtained by a VTA confined within the subthalamic nucleus and a larger radial distance in the best stimulation direction, while steering the VTA away from unwanted fiber tracts outside the nucleus. Applying the same concepts at a larger scale and in chronically implanted patients may help to predict the best stimulation area.


Assuntos
Estimulação Encefálica Profunda/métodos , Doença de Parkinson/terapia , Núcleo Subtalâmico/efeitos da radiação , Adulto , Idoso , Sistema Nervoso Central/fisiopatologia , Sistema Nervoso Central/efeitos da radiação , Estimulação Encefálica Profunda/efeitos adversos , Estimulação Elétrica , Eletrodos Implantados , Campos Eletromagnéticos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contração Muscular/efeitos da radiação , Doença de Parkinson/fisiopatologia , Núcleo Subtalâmico/fisiopatologia
11.
BMC Neurol ; 19(1): 137, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234792

RESUMO

BACKGROUND: Dystonia is a movement disorder substantially affecting the quality of life and the ability to work. A proportion of patients does not respond to first line pharmacotherapy. Deep brain stimulation (DBS) is established as a primary operative treatment option for severe drug resistant dystonia. We studied dystonia patients treated with DBS in Finland between the years 2007-2016 to evaluate the use and outcomes of DBS treatment. METHODS: We analysed the hospital records of dystonia patients, who underwent DBS operation during 2007-2016 in Finland. The clinical and technical parameters were recorded as well as preoperative assessments and treatments. The response to DBS was evaluated retrospectively using the Global Dystonia Rating Scale (GDS). RESULTS: Out of 585 dB implantations during the study period, 37 were done for dystonia. The clinical response improved significantly with time in the isolated focal dystonia group, and at 12 months, 22 of 32 patients had over 50% alleviation of the GDS score. There was only one subclinical intracerebral haemorrhage, and four infections leading to revision. Speech impairment and limb coordination problems were common stimulation- related adverse events and were mostly resolved or relieved with the adjustment of stimulation parameters. CONCLUSIONS: DBS seems to be beneficial in dystonia. Although DBS is indicated for dystonia in Finland, the number of operations did not increase at the same rate as DBS operations in general. DBS appears to be a safe and effective treatment for focal as well as generalized dystonia.


Assuntos
Estimulação Encefálica Profunda/estatística & dados numéricos , Distúrbios Distônicos/terapia , Adulto , Estimulação Encefálica Profunda/efeitos adversos , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
Rev. Hosp. Ital. B. Aires (2004) ; 39(2): 64-66, jun. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1048015

RESUMO

El trastorno obsesivo-compulsivo (TOC) afecta al 2% de la población general, llegando en ocasiones a causar un deterioro funcional severo y de la calidad de vida de las personas afectadas. Entre el 10 y el 30% de los pacientes con este trastorno no responde a los tratamientos recomendados: farmacológicos y terapia cognitivo-conductual. La Food and Drug Administration de los Estados Unidos (FDA) aprobó en el año 2008 la Estimulación cerebral profunda (ECP) para pacientes con TOC resistente a tratamiento. La ECP, utilizada frecuentemente para el tratamiento de la enfermedad de Parkinson refractaria, es una opción viable para los pacientes con TOC resistente, con efectos adversos poco frecuentes y transitorios. (AU)


Obsessive-compulsive disorder (OCD) affects 2% of the general population, sometimes resulting in severe impairment of functional capacity and quality of life of affected people. Between 10 and 30% of these patients do not respond to recommended treatments: pharmacological and cognitive behavioral therapy. In 2008, the FDA approved Deep Brain Stimulation (DBS) for patients with OCD resistant to treatment. DBS, frequently used for the treatment of refractory Parkinson's disease, is a viable option for the treatment of patients with resistant OCD, with infrequent and transient adverse effects. (AU)


Assuntos
Humanos , Estimulação Encefálica Profunda/métodos , Transtorno Obsessivo-Compulsivo/terapia , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Qualidade de Vida , Sinais e Sintomas , Estimulação Encefálica Profunda/efeitos adversos , Estimulação Encefálica Profunda/tendências , Transtornos Mentais/cirurgia , Transtorno Obsessivo-Compulsivo/complicações , Transtorno Obsessivo-Compulsivo/etiologia , Transtorno Obsessivo-Compulsivo/tratamento farmacológico
13.
Neurology ; 93(1): e97-e105, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31101738

RESUMO

OBJECTIVE: To determine the postoperative attempted and completed suicide rates after subthalamic nucleus deep brain stimulation (STN-DBS) in a single-center cohort and to determine factors associated with attempted and completed suicide. METHODS: We retrospectively included all patients with Parkinson disease (PD) who underwent bilateral STN-DBS surgery at the Grenoble University Hospital between 1993 and 2016. For each patient who committed or attempted suicide, 2 patients with PD with STN-DBS without any suicidal behaviors were matched for age (±1 year), sex, and year of surgery (±2 years). Clinical data were collected from medical records. Detailed preoperative and postoperative neuropsychological evaluations, including frontal and Beck Depression Inventory (BDI) scores, were gathered. RESULTS: A total of 534 patients with PD were included. Completed and attempted suicide percentages were 0.75% (4 of 534) and 4.11% (22 of 534), respectively. The observed suicide rate in the first postoperative year (187.20 of 100,000 per year, 1 of 534) was higher than the expected National Observatory on Suicide Risks rate adjusted for age and sex (standardized mortality ratio 8.1). This rate remained similar over the second and third postoperative years. In a comparison of the 26 patients completing/attempting suicide and the 52 controls, the first group showed more frequent history of suicidal ideation/suicide attempts and psychotic symptoms, higher percentage of family psychiatric history, higher psychiatric medication use, and higher preoperative frontal and BDI scores on neuropsychological evaluations. CONCLUSIONS: Suicide behaviors can occur after STN-DBS, especially during the first 3 years. A careful multidisciplinary assessment and long-term follow-up are recommended to recognize and treat this potentially preventable risk for mortality.


Assuntos
Estimulação Encefálica Profunda/efeitos adversos , Doença de Parkinson/psicologia , Doença de Parkinson/terapia , Suicídio , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/mortalidade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Núcleo Subtalâmico
14.
Stereotact Funct Neurosurg ; 97(2): 132-136, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31055582

RESUMO

Deep brain stimulation of the anterior thalamic nucleus is one of the promising therapeutic options for epilepsy. Several studies are still under way to further strengthen and clarify the mechanism, efficacy, and complications. Contrary to hardware-related and operation-related events, the stimulation-related adverse effect is mild, target-dependent, and adjustable. We present a case of relapsing herpes simplex encephalitis (HSE) as a newly reported and potentially fatal stimulation-related adverse effect following stimulation of the anterior thalamic nucleus (ANT-DBS) accompanied by fever, confusion, and cognitive impairment in a 32-year-old epileptic patient with a history of herpes meningoencephalitis 31 years earlier. The T2-weighted/FLAIR high-signal intensity in the temporal lobe developed at a "distance" from the stimulation target. The positive polymerase chain reaction of herpes virus deoxyribonucleic acid in the cerebrospinal fluid confirmed the diagnosis. The condition improved partially on acyclovir and stimulation stopped. Seizures disappeared and then returned after few months. The unique case report presents a rationale for considering history of herpes encephalitis as a relative contraindication for ANT-DBS, and HSE relapse should be suspected in patients with post-stimulation fever and/or altered consciousness.


Assuntos
Núcleos Anteriores do Tálamo/fisiologia , Estimulação Encefálica Profunda/efeitos adversos , Epilepsia Resistente a Medicamentos/terapia , Encefalite/etiologia , Adulto , Estimulação Encefálica Profunda/métodos , Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Encefalite/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Recidiva
15.
BMJ Case Rep ; 12(5)2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092485

RESUMO

Parkinsonism-hyperpyrexia syndrome (PHS) is a neurologic potentially fatal emergency that mimics neuroleptic malignant syndrome. It commonly presents as systemic inflammatory response syndrome, acute onset worsening of muscular rigidity, autonomic instability, hyperpyrexia, confusion, diaphoresis and high creatine phosphokinase. The most common trigger for PHS is reduction or withdrawal of anti-Parkinson's medications, especially levodopa. It was also reported in a few cases following deep brain stimulation of the subthalamic nucleus surgery shortly after anti-Parkinson's medications were discontinued. Rare causes of PHS include deep brain stimulator (DBS) malfunction due to battery depletion. To the best of our knowledge, PHS following DBS battery depletion was reported only in three occasions. Here, we report a case of PHS due to DBS battery depletion presented as sepsis and was successfully treated with the administration of dopamine agonists, intravenous fluids and changing the DBS battery.


Assuntos
Antiparkinsonianos/efeitos adversos , Estimulação Encefálica Profunda/efeitos adversos , Doença de Parkinson/terapia , Síndrome de Abstinência a Substâncias/diagnóstico , Doença Aguda , Idoso , Antiparkinsonianos/administração & dosagem , Feminino , Humanos
16.
Rev Assoc Med Bras (1992) ; 65(4): 541-546, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31066807

RESUMO

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Assuntos
Estimulação Encefálica Profunda/métodos , Doença de Parkinson/terapia , Antiparkinsonianos/uso terapêutico , Brasil , Tomada de Decisão Clínica , Estimulação Encefálica Profunda/efeitos adversos , Humanos , Levodopa/uso terapêutico , Atividade Motora , Doença de Parkinson/fisiopatologia , Fatores de Risco , Resultado do Tratamento
17.
J Clin Neurosci ; 64: 1-3, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31029525

RESUMO

Occurrence of gliomas in patients with chronic deep brain stimulation (DBS) has been reported few. It has been speculated whether there could be a causal relationship. Here, we report the development of a pilocytic astrocytoma in close vicinity of a DBS electrode during the course of chronic DBS. A 38-year-old man with refractory dystonic head tremor underwent bilateral implantation of quadripolar DBS electrodes in the thalamic ventral intermediate nucleus. He benefited markedly from chronic DBS. At age 46 he was admitted with head and neck pain, attention deficits and sensory disturbances. Cranial computed tomography and magnetic resonance imaging (MRI) showed a subcortical tumor originating from the right pulvinar. Surgery was performed with neuronavigation guidance and the tumor was subtotally removed. The neuropathological examination revealed a pilocytic astrocytoma WHO Grade I. Postoperative MRI demonstrated a small remnant tumor without increase in size during 1 year follow-up after adjuvant radiation therapy. He had ongoing benefit of his tremor with continued DBS. To our knowledge, there have been only three case reports published before indicating such a co-occurrence. In all of these reports, the tumors were high-grade gliomas. It is estimated that about 160.000 patients have been treated with DBS worldwide to date. Even if one would take into account that glial tumors would develop only with chronic DBS after several years and that a significant number of patients didn't reach such long term follow-up the resulting probability of brain tumor development most likely wouldn't be higher as the expectation of mere coincidence.


Assuntos
Astrocitoma , Neoplasias Encefálicas , Estimulação Encefálica Profunda , Tremor/terapia , Astrocitoma/etiologia , Astrocitoma/cirurgia , Neoplasias Encefálicas/etiologia , Neoplasias Encefálicas/cirurgia , Estimulação Encefálica Profunda/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade
18.
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
19.
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
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