What should we do to reduce the complications of Deep brain stimulation in Parkinson's disease?

Abstract

Parkinson's Disease (PD) is one of the most common neurodegenerative disorders. Recently, Deep Brain Stimulation (DBS) was proposed as a potential therapeutic approach for PD patients. This procedure has side effects that can be divided into three categories: stimulation-related, surgery-related, and hardware-related side effects. Stimulation-related complications are also divided into motors such as paresthesia and dysarthria, while non-motor contains cognitive decline and depression. The most important complication related to surgery is intracerebral hemorrhage (ICH). Side effects related to Hardware consist mainly of erosion and infections. Choosing the appropriate patient for DBS implantation has a critical role in reducing side effects. Adaptive or closed-loop DBS stimulates the brain by adjusting the parameters in response to feedback from the body and produce electrical flow when it is. New directional leads provide the ability to shape and steer the current to avoid stimulation of unwanted regions. Using Magnetic resonance imaging (MRI) instead of Microelectrode Recording (MER) allows surgery under general anesthesia and reduces the risk of ICH. Also, Interleaving Stimulation (ILS) can be a second option for those patients whom conventional programming does not effective. Choosing the right trajectory and keeping a distance from the vascular areas during lead placement also reduces the risk of hemorrhage.

Keywords

• deep brain stimulation
• side effects
• adaptive dbs
• directional leads
• microelectrode recording
• parkinson's disease