Reuters: High complication rate seen with DBS

[janet paterson <janet313@xxxxxxxxxxx>]

High complication rate seen with brain stimulation

Last Updated: 2002-06-03 13:00:33 -0400 - NEW YORK (Reuters Health) -
Patients with Parkinson's disease and other similar conditions often
benefit from a technique that uses implanted electrodes to electrically
stimulate a portion of the brain, but about one quarter may also experience
complications from the treatment hardware, according to Canadian researchers.

"Hardware-related complications may be even more troublesome than
stimulation-related side effects," write Dr. Andres M. Lozano and
colleagues from the University of Toronto.

The procedure, called deep brain stimulation (DBS), involves surgery to
place a tiny, platinum alloy electrode in a specific location in the
brain's gray matter. A small electric current - one to eight volts - is
then passed through the electrode via external leads to stimulate the
tissue. The patient is awake during the operation.

The goal of the electric current is to interrupt abnormal electrical
activity in the part of the brain where the electrode is implanted. This
procedure is used to treat movement disorders and chronic pain conditions
that do not respond to medication or other treatments.

However, previous research has suggested that a certain number of patients
may experience complications from the DBS equipment, such as a migration or
dislodgment of the leads, infection, or malfunctioning in one of the
components.

In this experiment, Lozano and his team followed 79 patients who received
DBS between 1993 and 1999. Most of the patients underwent the procedure for
Parkinson's disease, while smaller numbers received DBS to treat tremor,
pain or epilepsy. Patients were followed for an average of 3 years.

In total, 20 patients, or 25% of participants, experienced some sort of
hardware-related complication after the procedure.

Most of the complications stemmed from the electrode connectors, Lozano and
his team note. In terms of the types of complications, there were 4 lead
fractures, 4 lead migrations and 12 erosions and or infections, the authors
report in the June issue of Neurosurgery.

Study participants had to undergo a total of 29 additional operations to
treat these complications, the report indicates.

Lozano and his team point out that certain risk factors such as smoking,
scalp thickness or systemic disease likely affect the chances a patient
will develop complications, but the current study did not include enough
patients to link those risks to the patient outcomes.

"Neurosurgery clearly is still on a learning curve with regard to the
prevention of hardware-related complications in patients who undergo DBS,"
Dr. Roy A.E. Bakay of Rush Medical College in Chicago, Illinois, notes in
an accompanying editorial.

SOURCE: Neurosurgery 2002;50:1268-1276.
Copyright 2002 Reuters Limited.
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janet paterson: an akinetic rigid subtype, albeit primarily perky, parky
pd: 55/41/37 cd: 55/44/43 tel: 613 256 8340 email: janet313@xxxxxxxxxxx
smail: 375 Country Street, Almonte, Ontario, Canada, K0A 1A0
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