title: Skin complications in deep brain stimulation for Parkinson's disease: frequency, time course, and risk factors.
abstract: OBJECTIVE
  Deep brain stimulation (DBS) has been recognized as an efficacious treatment for movement disorders. Its beneficial effects however may be lost due to skin complications such as erosions or infections over the implanted foreign material. We sought to document skin complications in the entire Parkinson's disease patient population who received a DBS system at the Marburg/Kassel implantation centre since the start of our DBS program in January 2002 to analyze frequency, time course, and possible risk factors.
  
  
  METHODS
  We investigated 85 consecutive patients with Parkinson's disease (PD) from a single center/single surgeon DBS series for the occurrence of skin complications and analyzed localization, time course, and possible risk factors. Mean follow-up was 3 years (range 1-7 years).
  
  
  RESULTS
  In total, 21/85 patients (24.7%) suffered a total of 30 single skin complications. Sixty percent of all incidents occurred within the first post-operative year. Forty percent of all incidents occurred later than the first year following primary implantation. Complications involved the burr hole cap in 37%, the course of the cables in 33%, and the impulse generator (IPG) site in 30%. Six of 21 patients suffered recurring skin complications. Eight patients permanently lost their DBS system. Factor analysis for age, gender, disease duration, disease severity, the incidence of hypertension or diabetes as well as a 2-day period with externalized electrodes for continuous test stimulation did not have any statistically significant impact on skin complications.
  
  
  CONCLUSIONS
  We conclude that (1) PD patients have a risk for skin complications after DBS as long as the system remains in situ and (2) there are at present no identifiable risk factors for skin complications after DBS, other than PD itself.
authors.affiliation: Paracelsus-Elena-Klinik, Center of Parkinsonism and Movement Disorders, Klinikstr. 16, 34128 Kassel, Germany. friederike.sixel@pk-mx.de
authors.forename: Friederike
authors.initials: F
authors.lastname: Sixel-Döring
authors.forename: Claudia
authors.initials: C
authors.lastname: Trenkwalder
authors.forename: Christoph
authors.initials: C
authors.lastname: Kappus
authors.forename: Dieter
authors.initials: D
authors.lastname: Hellwig
mesh_terms: D017677:Age Distribution; D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D003872:Dermatitis / Q000209:etiology / Q000503:physiopathology; D048909:Diabetes Complications / Q000503:physiopathology; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications / Q000503:physiopathology; D005549:Foreign-Body Reaction / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications; D007049:Iatrogenic Disease / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D012871:Skin Diseases / Q000209:etiology* / Q000503:physiopathology; D013207:Staphylococcal Skin Infections / Q000209:etiology / Q000503:physiopathology; D013530:Surgical Wound Infection / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors