Short-term and long-term safety of deep brain stimulation in the treatment of movement disorders
Short-term and long-term safety of deep brain stimulation in the treatment of movement disorders
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DOI：
10.3171/jns.2007.106.4.621
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发表时间：
2007-04-01
影响因子：
4.1
通讯作者：
Jankovic, Joseph
中科院分区：
文献类型：
--
作者：
Kenney, Christopher;Simpson, Richard;Jankovic, Joseph
Object.本研究的目的是评估脑深部电刺激（DBS）在大量患有各种运动障碍的患者中的长期安全性。对1995年至2005年在作者中心接受DBS治疗的所有患者进行了术中、围手术期和长期不良事件（AE）评估。其中19，182人患有医学难治性帕金森病;其他患者有原发性震颤（112例），肌张力障碍（19例）和其他运动过度性运动障碍（6例）。术中AE罕见，包括8例患者（2.5%）的血管迷走神经反应、4例患者（1.2%）的晕厥、3例患者（0.9%）的严重咳嗽、1例患者（0.3%）的短暂性脑缺血发作、1例患者（0.3%）的心律失常和1例患者（0.3%）的意识模糊。围手术期AE包括48例患者（15.0%）的头痛、16例患者（5.0%）的意识模糊和9例患者（2.8%）的幻觉。严重术中/围手术期AE包括4例患者（1.2%）的孤立性癫痫发作、2例患者（0.6%）的脑内出血、2例患者（0.6%）的脑室内出血和1例患者（0.3%）的大面积硬膜下血肿。DBS手术的持续长期并发症包括构音障碍（4.0%）、步态恶化（3.8%）、认知功能障碍（4.0%）和感染（4.4%）。25例患者（7.8%）因以下原因完成翻修：失效、缺乏疗效、感染、电极导线断裂和电极导线移位。硬件相关并发症包括12例电极导线断裂和10例电极导线移位。作者得出结论，在其10年的经验中，DBS已被证明可安全用于治疗医学难治性运动障碍。
Object. The object of this Study was to assess the long-term safety of deep brain stimulation (DBS) in a large population of patients with a variety of movement disorders.Methods. All patients treated with DBS at the authors' center between 1995 and 2005 were assessed for intraoperative, perioperative, and long-term adverse events (AEs).A total of 3 19 patients underwent DBS device implantation. Of these 3 19, 182 suffered from medically refractory Parkinson disease; the other patients had essential tremor (112 patients), dystonia (19 patients), and other hyperkinetic movement disorders (six patients). Intraoperative AEs were rare and included vasovagal response in eight patients (2.5%), syncope in four (1.2%), severe cough in three (0.9%), transient ischemic attack in one (0.3%), arrhythmia in one (0.3%), and confusion in one (0.3%). Perioperative AEs included headache in 48 patients (15.0%), confusion in 16 (5.0%), and hallucinations in nine (2.8%). Serious intraoperative/perioperative AEs included isolated seizure in four patients (1.2%), intracerebral hemorrhage in two patients (0.6%), intraventricular hemorrhage in two patients (0.6%), and a large subdural hematoma in one patient (0.3%). Persistent long-term complications of DBS surgery included dysarthria (4.0%), worsening gait (3.8%), cognitive dysfunction (4.0%), and infection (4.4%). Revisions were completed in 25 patients (7.8%) for the following reasons: loss of effect, lack of efficacy, infection, lead fracture, and lead migration. Hardware-related complications included 12 lead fractures and 10 lead migrations.Conclusions. The authors conclude that in their 10-year experience, DBS has proven to be safe for the treatment of medically refractory movement disorders.