gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Transitory confusion syndrome after deep brain stimulation surgery in Parkinson’s disease

Meeting Abstract

  • Silvia Johannes - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum Würzburg
  • Almuth Kessler - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum Würzburg
  • Patrick Fricke - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum Würzburg
  • Ralf-Ingo Ernestus - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum Würzburg
  • Frank Steigerwald - Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg
  • Jens Volkmann - Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg
  • Cordula Matthies - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum Würzburg

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMI.04.08

doi: 10.3205/13dgnc308, urn:nbn:de:0183-13dgnc3087

Published: May 21, 2013

© 2013 Johannes et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Transitory confusion syndrome is a rare, but well known phenomenon in patients with Parkinson's disease (PD) after deep brain stimulation (DBS) surgery in the subthalamic nucleus (STN). The inferior part of the STN is speculated to be especially sensitive for psychological disturbances. The focus of this present study was the possible influence of intra-operative recording and stimulation of this region.

Method: In a consecutive series of 16 patients with PD undergoing microelectrode recording and test stimulation the mode of application regarding number, micro- and/or semimacro-electrode placement and depths of stimulation were analyzed and correlated to pre-operative evaluation and to the early post-operative course.

Results: All the 16 PD patients were treated bilaterally and received a total of 122 micro/semimacro-electrodes. In 3 patients (19%) a temporary confusion syndrome occurred for a maximum of 2 weeks. Number of electrodes per patient ranged from 4 to 10, on average 7.6 electrodes were applied. Maximum depth of microelectrode insertion was 5 to 6 millimeters below AC-PC-line, performed with 118 electrodes. To these deepest sites, 38 semimacro-electrodes were inserted and tested by stimulation in 14 patients. Neither electrode number nor stimulation intensity could be identified as different in the 3 affected patients compared to those with an uneventful course. All the 3 patients had presented with signs of impulse control disturbance previously. Furthermore, no relation to post-operative stimulation trials could be identified.

Conclusions: Deep insertion of microelectrodes and application of macro-stimulation in the lower part of the STN is well tolerated by most PD patients. At present, a history of impulse control disturbance seems to be the most important warning sign for a risk of transitory confusion syndrome rather than the mode of intra-operative testing.