S Reuter1, G Deuschl1, D Berg2, A Helmers3, D Falk3, K Witt4. 1. Department of Neurology, University Medical Center Schleswig-Holstein, Christian Albrechts University, Rosalind-Franklin-Strasse, Kiel, Germany. 2. Department of Neurology, University Medical Center Schleswig-Holstein, Christian Albrechts University, Rosalind-Franklin-Strasse, Kiel, Germany. Electronic address: daniela.berg@uksh.de. 3. Department of Neurosurgery, University Medical Center Schleswig-Holstein, Christian Albrechts University, Rosalind-Franklin-Strasse, Kiel, Germany. 4. Department of Neurology, University Medical Center Schleswig-Holstein, Christian Albrechts University, Rosalind-Franklin-Strasse, Kiel, Germany; Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany.
Abstract
INTRODUCTION: The deep brain stimulation (DBS) withdrawal syndrome (DBS-WDS) is a rare, life-threatening complication in Parkinson's disease (PD) patients with long disease duration and stimulation when stimulation is terminated for extended periods mostly due to infection of the DBS-hardware. METHODS, RESULTS: In five patients explantation became necessary because of infection after a mean of 11.4 years (range 4-15 years) of DBS and a mean disease duration of 24.6 years (range 3-22 years). Mean UPDRS motor-score pre-explantation was 38 points (range 24-55 points) which increased to a mean of 78.4 points (range 58-90 points) after explantation, despite optimal Levodopa dosing. Reimplantation of the hardware after 23 days (range 3-45 days) under antibiotic treatment led to an improvement to a mean of 40 points (range 25-73 points) and a complication free survival. CONCLUSION: Early reimplantation of the DBS-hardware is a treatment option of the DBS-WDS when the life-threatening urgency overrides surgical standards. Observation of the syndrome indicates pharmacological unresponsiveness of the dopaminergic system in advanced PD and long-term DBS.
INTRODUCTION: The deep brain stimulation (DBS) withdrawal syndrome (DBS-WDS) is a rare, life-threatening complication in Parkinson's disease (PD) patients with long disease duration and stimulation when stimulation is terminated for extended periods mostly due to infection of the DBS-hardware. METHODS, RESULTS: In five patients explantation became necessary because of infection after a mean of 11.4 years (range 4-15 years) of DBS and a mean disease duration of 24.6 years (range 3-22 years). Mean UPDRS motor-score pre-explantation was 38 points (range 24-55 points) which increased to a mean of 78.4 points (range 58-90 points) after explantation, despite optimal Levodopa dosing. Reimplantation of the hardware after 23 days (range 3-45 days) under antibiotic treatment led to an improvement to a mean of 40 points (range 25-73 points) and a complication free survival. CONCLUSION: Early reimplantation of the DBS-hardware is a treatment option of the DBS-WDS when the life-threatening urgency overrides surgical standards. Observation of the syndrome indicates pharmacological unresponsiveness of the dopaminergic system in advanced PD and long-term DBS.
Authors: Julius Kricheldorff; Katharina Göke; Maximilian Kiebs; Florian H Kasten; Christoph S Herrmann; Karsten Witt; Rene Hurlemann Journal: Brain Sci Date: 2022-07-15
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Authors: Svjetlana Miocinovic; Jill L Ostrem; Michael S Okun; Katie L Bullinger; Patricio Riva-Posse; Robert E Gross; Cathrin M Buetefisch Journal: J Parkinsons Dis Date: 2020 Impact factor: 5.568