Complications of deep brain stimulation

Abstract

Two recent double-blinded multicenter studies that compared the effects of deep brain stimulation (DBS) and the best medication therapy have shown that DBS has better effects than the best medication on improving the motor symptoms and the quality of life of patients with Parkinson’s disease. However, they have also shown a higher incidence rate of complications in the groups treated with DBS. These findings have suggested that methods that result in the avoidance of these complications need to be determined. Complications related to DBS are divided into the following three categories: (1) complications related to surgical procedures, which includes intracranial hemorrhages, infections, epilepsy, and air embolisms; (2) complications related to problems with the DBS machinery or wiring, including machinery breakdown, electrode breakage, skin erosion above the implantable pulse generator or electric wires, and related infection; and (3) complications related to DBS-stimulated neuronal structures or networks, which includes not only paresthesia or scintillation related to thalamic sensory afferent fibers or optic tracts, but also psychiatric or cognitive malfunction and increased risks for suicide after DBS. This chapter discusses the incidence rates and risk factors for each complication. In addition, a number of methods are suggested that help to avoid these complications, which includes our guidelines based on our own experiences.