Atrophy and other potential factors affecting long term deep brain stimulation response: a case series

To describe three DBS cases which presented with new side effects or loss of benefit from stimulation after long-term follow-up and to discuss the potential contributing factors. A University of Florida (UF) database (INFORM) search was performed, identifying three patients, two Parkinson's dis...

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Veröffentlicht in:PloS one 2014-10, Vol.9 (10), p.e111561-e111561
Hauptverfasser: Martinez-Ramirez, Daniel, Morishita, Takashi, Zeilman, Pamela R, Peng-Chen, Zhongxing, Foote, Kelly D, Okun, Michael S
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Sprache:eng
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Zusammenfassung:To describe three DBS cases which presented with new side effects or loss of benefit from stimulation after long-term follow-up and to discuss the potential contributing factors. A University of Florida (UF) database (INFORM) search was performed, identifying three patients, two Parkinson's disease (PD) and one Essential Tremor (ET), with an unexpected change in long-term programming thresholds as compared to initial evaluation. Clinical follow-up, programming, imaging studies, and lead measurements were reviewed. The UF Institutional Review Board (IRB) approved this study. A substantial increase in the 3rd ventricular width (120%), Evans index (6%), ventricular index (5%), and cella media index (17%) was uncovered. A change in thresholds across lead contacts with a decrease in current densities as well as a relative lateral change of lead location was also observed. Hardware-related complications, lead migration, and impedance variability were not identified. Potential factors contributing to long-term side effects should be examined during a DBS troubleshooting assessment. Clinicians should be aware that in DBS therapy there is delivery of electricity to a changing brain, and atrophy may possibly affect DBS programming settings as part of long-term follow-up.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0111561