| Autor: |
Roldan, Pedro, Real, Luis, Salvador, Antonio, Tabares, Diego, Capilla, Pau, Pastor, Felix, Lainez-Andres, Jose-Miguel, Gonzalez-Darder, Jose |
| Zdroj: |
Stereotactic & Functional Neurosurgery; 2017 Supplement, Vol. 95, p374-374, 2/3p |
| Abstrakt: |
Objectives: After the initial description by Hariz and Johansson in January 2001 in the Journal of Movement Disorders, drawing attention to the consequences of the abrupt cessation of chronic STN DBS (Subthalamic Nucleus Deep Brain Stimulation) in PD (Parkinson's Disease) patients, describing how this therapy can change patients' symptomatology into an acute condition with severe rebound of PD symptoms requiring emergency care if chronic stimulation fails, this condition has remain hidden in some way. Methods: We present 2 cases with PD, male and female, 50 and 74 yrs old. In both cases initial DBS induced a significant improvement of symptoms without adverse effects. They were operated as usual using a Frameless System. Awake microrrecordings and stimulation were always obtained to assess STN targeting and absence of adverse side-effects. In the first case admission to Hospital in the ICU was due to a pneumonia, and after 10 days and verified the battery was off its replacement was performed. His Hoehn & Yahr state changed from 5 to 2 after operation. In the second case two similar episodes were present, the first 4 yrs after the first operation with pneumonia, the stimulator being replaced one month after admission, and a second one 3 yrs afterwards, the battery being replaced after 10 days, for a severe urinary tract infection and septic state. Her Hoehn & Yahr state changed from 5 to 3 after replacement. Both cases presented with severe systemic and neurological deterioration, including rigidity, akinesia, dysphagia, pneumonia and severe respiratory distress Results: In both cases quickly after the stimulator run out of battery, patients deteriorated unadvertedly systemic and neurologically early with severe rigidity and urinary or lung infections, that were attributed to their previous neurological condition and even required its emergency admission to the ICU. Emergency replacement of the stimulator stopped the deterioration of the patient. Dopaminergic medication was not an effective treatment. Just the stimulator replacement changed the clinical course. Some deterioration in their neurological state remained even after replacement. Conclusion: Other reports including the parkinsonian hyperpyrexia syndrome or psychiatric conditions related to DBS are not related. Deterioration was due to battery depletion shortly before replacement. Emergency stimulator replacement is mandatory in these cases. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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