ABSTRACT
No disponible
Subject(s)
Humans , Deep Brain Stimulation/instrumentation , Equipment Failure , Electrodes, ImplantedABSTRACT
No disponible
Subject(s)
Humans , Deep Brain Stimulation/trends , Central Nervous System Diseases/therapy , Dyskinesias/therapySubject(s)
Deep Brain Stimulation , Mental Disorders/therapy , Movement Disorders/therapy , Clinical Trials as Topic , Deep Brain Stimulation/methods , Deep Brain Stimulation/trends , Depressive Disorder/therapy , Double-Blind Method , Dystonic Disorders/therapy , Epilepsy/therapy , Humans , Multicenter Studies as Topic , Obsessive-Compulsive Disorder/therapy , Parkinson Disease/therapy , Persistent Vegetative State/therapy , Tourette Syndrome/therapy , Tremor/therapyABSTRACT
La estimulación cerebral profunda es una técnica quirúrgica que ha alcanzado un importante desarrollo para el tratamiento de diferentes trastornos del movimiento como la enfermedad de Parkinson, el temblor o la distonía. Debido al importante crecimiento en el número de pacientes tratados, se han publicado cada vez con mayor frecuencia nuevas complicaciones de la cirugía. El bowstringing se define como una tensión anormal de las extensiones eléctricas situadas entre los electrodos y la batería, acompañada de una sensación de dolor y tensión a nivel cervical, en la zona donde se encuentran los cables. Presentamos el caso clínico de una mujer de 56 años con enfermedad de Parkinson que fue tratada con la implantación bilateral de electrodos subtalámicos. Después de un accidente de tráfico presentó ruptura del electrodo derecho, que fue recambiado. Seis meses más tarde acude por dolor y tensión en el cuello. Fue necesario realizar un abordaje cervical a los cables para extirpar el tejido cicatricial que se había formado .El bowstringing es una complicación poco habitual en este tipo de cirugía, y aunque algunos pacientes refieren molestias y tensión en el cuello, pocas veces es necesario su abordaje quirúrgico (..) (AU)
Subject(s)
Humans , Female , Middle Aged , Deep Brain Stimulation/adverse effects , Parkinson Disease/therapy , Electrodes/adverse effectsABSTRACT
Deep brain stimulation (DBS) is an established surgical therapy for intractable movement disorders, such as Parkinson's disease, essential tremor and dystonia. As the number of treated patients has increased rapidly, new sets of problems about complications of DBS have arisen. Bowstringing is defined as abnormal tethering of leads between the pulse generators and stimulating electrode, associated with pain and contracture of the neck over the extension cable. We report the case of a 56-year-old woman with a history of advanced Parkinson's disease who had been treated by implantation of a bilateral, subthalamic nucleus, deep brain stimulator. A car accident caused the rupture of the right electrode, which was replaced. Six months after the replacement the patient presented disabling pain and tension in the neck where deep brain extension cables were located. A cervical incision was performed to excise scar tissue. Bowstringing is a rare complication of DBS and although patients sometimes report discomfort and tension in the cervical region, surgical procedures are not normally required.
Subject(s)
Deep Brain Stimulation/adverse effects , Electrodes, Implanted/adverse effects , Foreign-Body Migration/etiology , Neck Pain/etiology , Accidents, Traffic , Cicatrix/etiology , Device Removal , Equipment Failure , Female , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/surgery , Head Movements , Humans , Magnetic Resonance Imaging , Middle Aged , Multimodal Imaging , Neck Pain/diagnostic imaging , Neck Pain/surgery , Parkinson Disease/complications , Parkinson Disease/therapy , Stress, Mechanical , Tomography, X-Ray ComputedABSTRACT
Twiddler syndrome occurs when a patient intentionally or unintentionally manipulates an implantable generator (usually a pacemaker) and dislodges the pacing leads, causing malfunction of the device. Though the syndrome has been described in patients with pacemakers, to our knowledge only one spontaneous case has been described in patients undergoing deep brain stimulation for movement disorders. We report the clinical cases of two patients with Parkinson's disease who had subthalamic bilateral electrodes implanted and presented the twiddler syndrome 2 and 3 years after surgery. We analysed the possible mechanisms of this syndrome and note that twiddler syndrome should be suspected in patients undergoing deep brain stimulation and showing hardware dysfunction.
