Identification and management of deep brain stimulation intra- and postoperative urgencies and emergencies

Morishita, Takashi; Foote, Kelly D.; Burdick, Adam P.; Katayama, Yoichi; Yamamoto, Takamitsu; Frucht, Steven J.; Okun, Michael S.

doi:10.1016/j.parkreldis.2009.10.003

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Volume 16, Issue 3 , Pages 153-162, March 2010

Identification and management of deep brain stimulation intra- and postoperative urgencies and emergencies☆

Takashi Morishita
- Department of Neurology, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL, USA
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
Kelly D. Foote
- Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL, USA
Adam P. Burdick
- Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL, USA
Yoichi Katayama
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
- Division of Applied System Neuroscience, Department of Advanced Medical Science, Nihon University School of Medicine, Tokyo, Japan
Takamitsu Yamamoto
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
- Division of Applied System Neuroscience, Department of Advanced Medical Science, Nihon University School of Medicine, Tokyo, Japan
Steven J. Frucht
- Department of Neurology, Columbia University College of Physicians and Surgeons/Columbia-Presbyterian Medical Center, New York, NY, USA
Michael S. Okun
- Department of Neurology, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL, USA
- Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL, USA
- Corresponding author at: Department of Neurology, McKnight Brain Institute, Medical Director National Parkinson Foundation, 100 S Newell Dr, Room L3-101, Gainesville, FL 32610, USA. Tel.: +1 352 273 5550; fax: +1 352 273 5575.

Received 30 June 2009; received in revised form 23 September 2009; accepted 1 October 2009.

Abstract

Deep brain stimulation (DBS) has been increasingly utilized for the therapeutic treatment of movement disorders, and with the advent of this therapy more postoperative urgencies and emergencies have emerged. In this paper, we will review, identify, and suggest management strategies for both intra- and postoperative urgencies and emergencies. We have separated the scenarios into 1 – surgery/procedure related, 2 – hardware related, 3 – stimulation-induced difficulties, and 4 – others. We have included ten illustrative (and actual) case vignettes to augment the discussion of each issue.

Keywords: Deep brain stimulation, Movement disorders, Emergency, Differential diagnosis, Adverse event