Short-term and long-term safety of deep brain stimulation in the treatment of movement disorders.
OBJECTIVE
The object of this study was to assess the long-term safety of deep brain stimulation (DBS) in a large population of patients with a variety of movement disorders.


METHODS
All patients treated with DBS at the authors' center between 1995 and 2005 were assessed for intraoperative, perioperative, and long-term adverse events (AEs). A total of 319 patients underwent DBS device implantation. Of these 319, 182 suffered from medically refractory Parkinson disease; the other patients had essential tremor (112 patients), dystonia (19 patients), and other hyperkinetic movement disorders (six patients). Intraoperative AEs were rare and included vasovagal response in eight patients (2.5%), syncope in four (1.2%), severe cough in three (0.9%), transient ischemic attack in one (0.3%), arrhythmia in one (0.3%), and confusion in one (0.3%). Perioperative AEs included headache in 48 patients (15.0%), confusion in 16 (5.0%), and hallucinations in nine (2.8%). Serious intraoperative/perioperative AEs included isolated seizure in four patients (1.2%), intracerebral hemorrhage in two patients (0.6%), intraventricular hemorrhage in two patients (0.6%), and a large subdural hematoma in one patient (0.3%). Persistent long-term complications of DBS surgery included dysarthria (4.0%), worsening gait (3.8%), cognitive dysfunction (4.0%), and infection (4.4%). Revisions were completed in 25 patients (7.8%) for the following reasons: loss of effect, lack of efficacy, infection, lead fracture, and lead migration. Hardware-related complications included 12 lead fractures and 10 lead migrations.


CONCLUSIONS
The authors conclude that in their 10-year experience, DBS has proven to be safe for the treatment of medically refractory movement disorders.
Kenney
Christopher
C
Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA. kenney@bcm.edu
Simpson
Richard
R
Hunter
Christine
C
Ondo
William
W
Almaguer
Michael
M
Davidson
Anthony
A
Jankovic
Joseph
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000628:therapy*; D012189:Retrospective Studies; D020531:Subthalamic Nucleus; D013997:Time Factors; D016896:Treatment Outcome; D020651:Ventral Thalamic Nuclei