Recommendations for Deep Brain Stimulation Device Management During a Pandemic

Autor: Michael S. Okun, Svjetlana Miocinovic, Robert E. Gross, Patricio Riva-Posse, Cathrin M. Buetefisch, Katie L Bullinger, Jill L. Ostrem
Rok vydání: 2020
Předmět:
0301 basic medicine
medicine.medical_specialty
Deep brain stimulation
Deep Brain Stimulation
medicine.medical_treatment
Pneumonia
Viral
coronavirus
Tourette syndrome
Betacoronavirus
03 medical and health sciences
Cellular and Molecular Neuroscience
Epilepsy
0302 clinical medicine
Intervention (counseling)
medicine
Humans
Viral
Intensive care medicine
Pandemics
Depression (differential diagnoses)
Dystonia
Essential tremor
SARS-CoV-2
business.industry
Neurosciences
COVID-19
Disease Management
Parkinson Disease
Pneumonia
medicine.disease
Status dystonicus
Implantable Neurostimulators
030104 developmental biology
Practice Guidelines as Topic
Commentary
battery depletion
Equipment Contamination
DBS withdrawal
Biochemistry and Cell Biology
telemedicine
Neurology (clinical)
Coronavirus Infections
business
030217 neurology & neurosurgery
Zdroj: Journal of Parkinson's Disease
Journal of Parkinson's disease, vol 10, iss 3
ISSN: 1877-718X
1877-7171
DOI: 10.3233/jpd-202072
Popis: Most medical centers are postponing elective procedures and deferring non-urgent clinic visits to conserve hospital resources and prevent spread of COVID-19. The pandemic crisis presents some unique challenges for patients currently being treated with deep brain stimulation (DBS). Movement disorder (Parkinson's disease, essential tremor, dystonia), neuropsychiatric disorder (obsessive compulsive disorder, Tourette syndrome, depression), and epilepsy patients can develop varying degrees of symptom worsening from interruption of therapy due to neurostimulator battery reaching end of life, device malfunction or infection. Urgent intervention to maintain or restore stimulation may be required for patients with Parkinson's disease who can develop a rare but potentially life-threatening complication known as DBS-withdrawal syndrome. Similarly, patients with generalized dystonia can develop status dystonicus, patients with obsessive compulsive disorder can become suicidal, and epilepsy patients can experience potentially life-threatening worsening of seizures as a result of therapy cessation. DBS system infection can require urgent, and rarely emergent surgery. Elective interventions including new implantations and initial programming should be postponed. For patients with existing DBS systems, the battery status and electrical integrity interrogation can now be performed using patient programmers, and employed through telemedicine visits or by phone consultations. The decision for replacement of the implantable pulse generator to prevent interruption of DBS therapy should be made on a case-by-case basis taking into consideration battery status and a patient's tolerance to potential therapy disruption. Scheduling of the procedures, however, depends heavily on the hospital system regulations and on triage procedures with respect to safety and resource utilization during the health crisis.
Databáze: OpenAIRE
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