Open AccessAtrophy and Other Potential Factors Affecting Long Term Deep Brain Stimulation Response: A Case Series
Author(s) -
Daniel Martínez-Ramírez,
Takashi Morishita,
Pamela Zeilman,
Zhongxing Peng-Chen,
Kelly D. Foote,
Michael S. Okun
Publication year - 2014
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0111561
Subject(s) - deep brain stimulation , lead (geology) , medicine , atrophy , physical medicine and rehabilitation , parkinson's disease , disease , physical therapy , surgery , pathology , biology , paleontology
Objective 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. Methods 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. Results A substantial increase in the 3 rd 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. Conclusions 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.