Jing Jing- Neuroscience Column Delayed complications of electrical stimulation in the deep brain

Today you are sharing the"Jingyu - Neuroscience Column"57th issue, by theTimbrought about by the"deep brain electrical stimulation of late complications", the content is wonderful, welcome to readRef:Fern?ndez-Pajar?n G,et al.Acta Neurochir (Wien). 2017 Jun 24doi: 10.1007/s00701-017-3252-7(Epub ahead of print)Since 1990, the efficacy of deep brain electrical stimulation (DBS) in the clinical treatment of many neurological diseases has become more and more significant Most of the complications of DBS surgery are associated with the surgery itself or electrical stimulation, but some patients experience complications from implantation materials Recently, Gustavo Fern?ndez-Pajar?n of the Department of Neurology at the University Hospital of Santiago, Spain, and others studied material-related delayed complications after DBS surgery, published online in The Acta Neurochir (Wien) in June 2017 the study included patient data on 249 routine DBS surgeries between January 2000 and December 2016 for retrospective analysis 249 patients involved 321 implants; Of the 249 patients , the most common disease was 229 cases of Parkinson's disease, followed by 7 cases of iexclusiveidal tremor, 4 cases of iexclusiveidized systemic dystonia disorder, 3 cases of myoclonic dystonia disorder and 3 cases of symptomatic tremor In the 24 months after DBS surgery, the most common late complication was infection, accounting for 12.5%, while the pulse generator (IPG) electrode implant was the site of the infection In addition, the damage caused by the wire to the scalp is also a good hair site of infection (9.3%) (Figure 1), due to damage to the wire or the use of long-term damage to the scalp and exposed, the incidence is significantly higher than previously reported Other complications associated with DBS materials include complications caused by the twiddler sign i.e IPG rotation around the axis, IPG shift, electrode damage or contact electrode shift, and the formation of edema and cysts around the electrode (Figure 2-3) After DBS implantation, MRI-T2 imaging the high density surrounding the visible electrode was mostly clinically free, with an incidence rate of 6.3% Cysts appear in the brain around the electrodes, possibly due to the development of cerebral edema The group had 2 patients with cyst formation, and after removing the DBS device, there were no signs of infection and blood tests were normal The biochemical analysis of cyst fluid in the brain conforms to the characteristics of normal cerebrospinal fluid Both patients were not treated with steroids, and after 12 months MRI scans showed a gradual reduction in cystic lesions (Figure 4) Figure 1 The location of the infection The left image is the pulse generator implant and the wire exposed on the right Figure 2 Twiddler and neck wire breaks Figure 3 The left-hand MRI imaging shows the edema around the electrode The above image: The shaft and coronal bits of the FLAIR sequence are left and right The figure below shows the same area after 3 months Figure 4 MRI imaging showed the cyst in the left brain and edema around the right electrode The axis and coronal positions of MRI-T1 are left and right The image of FLAIR in the same area the final authors point out that understanding the complications of DBS surgery can help with treatment Removing some DBS devices is a necessary means of dealing with infections Complications related to DBS materials, such as edema around the wire and cyst formation, have a good prognosis and can exist for a long time after DBS implantation, giving follow-up observation (
Tim compiled, Dr Chen Lingchao, of Huashan Hospital, Fudan University, reviewed by Dr Chen Lingchao, editor-in-chief of "Outside Information" and Chen Jingcheng Professor of Fudan University)