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

Domenico Servello; Tommaso Francesco Galbiati; Guglielmo Iess; Brigida Minafra; Mauro Porta; Claudio Pacchetti

doi:10.1007/s00701-023-05799-w

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

Acta Neurochir (Wien). 2023 Nov;165(11):3385-3396. doi: 10.1007/s00701-023-05799-w. Epub 2023 Sep 29.

Authors

Domenico Servello¹, Tommaso Francesco Galbiati², Guglielmo Iess¹, Brigida Minafra³, Mauro Porta¹, Claudio Pacchetti³

Affiliations

¹ Neurosurgical Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy.
² Neurosurgical Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy. tommaso.galbiati@libero.it.
³ Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy.

PMID: 37773459
DOI: 10.1007/s00701-023-05799-w

Abstract

Background: The number of deep brain stimulation (DBS) procedures is rapidly rising as well as the novel indications. Reporting adverse events related to surgery and to the hardware used is essential to define the risk-to-benefit ratio and develop novel strategies to improve it.

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

Methods: Five hundred seventeen cases of DBS for Parkinson's disease were performed between 2006 and 2021 in a single center (mean follow-up: 4.68 ± 2.86 years). Spearman's Rho coefficient was calculated to search for a correlation between the occurrence of intracerebral hemorrhage (ICH) and the number of recording tracks. Multiple logistic regression analyzed the probability of developing seizures and ICH given potential risk factors. Kaplan-Meier curves were performed to analyze the cumulative proportions of hardware-related complications.

Results: Mortality rate was 0.2%, while permanent morbidity 0.6%. 2.5% of cases suffered from ICH which were not influenced by the number of tracks used for recordings. 3.3% reported seizures that were significantly affected by perielectrode brain edema and age. The rate of perielectrode brain edema was significantly higher for Medtronic's leads compared to Boston Scientific's (Χ²(1)= 5.927, P= 0.015). 12.2% of implants reported Hardware-related complications, the most common of which were wound revisions (7.2%). Internal pulse generator models with smaller profiles displayed more favorable hardware-related complication survival curves compared to larger designs (X²(1)= 8.139, P= 0.004).

Conclusion: Overall DBS has to be considered a safe procedure, but future research is needed to decrease the rate of hardware-related complications which may be related to both the surgical technique and to the specific hardware's design. The increased incidence of perielectrode brain edema associated with certain lead models may likewise deserve future investigation.

Keywords: Deep brain stimulation; Hardware failure; Intracerebral hemorrhage; Parkinson’s disease; Surgical complications: Movement disorder.

MeSH terms

Brain Edema* / etiology
Cerebral Hemorrhage / epidemiology
Cerebral Hemorrhage / etiology
Deep Brain Stimulation* / adverse effects
Deep Brain Stimulation* / methods
Electrodes, Implanted / adverse effects
Humans
Parkinson Disease* / therapy
Retrospective Studies
Seizures / etiology