1
|
Miocinovic S, Ostrem JL, Okun MS, Bullinger KL, Riva-Posse P, Gross RE, Buetefisch CM. Recommendations for Deep Brain Stimulation Device Management During a Pandemic. JOURNAL OF PARKINSONS DISEASE 2020; 10:903-910. [PMID: 32333552 PMCID: PMC7458514 DOI: 10.3233/jpd-202072] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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.
Collapse
Affiliation(s)
| | - Jill L Ostrem
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gaineseville, FL, USA
| | | | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University, Atlanta, GA, USA
| | - Cathrin M Buetefisch
- Department of Neurology, Emory University, Atlanta, GA, USA.,Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| |
Collapse
|
2
|
Status dystonicus in pantothenate kinase-associated neurodegeneration due to internal pulse generator depletion: Case study and literature review. J Neurol Sci 2019; 400:44-46. [PMID: 30903858 DOI: 10.1016/j.jns.2019.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/11/2019] [Accepted: 02/27/2019] [Indexed: 11/20/2022]
|
3
|
Ruiz-Lopez M, Fasano A. Rethinking status dystonicus. Mov Disord 2017; 32:1667-1676. [PMID: 29144565 DOI: 10.1002/mds.27207] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/01/2017] [Accepted: 10/06/2017] [Indexed: 01/18/2023] Open
Abstract
Status dystonicus is a movement disorder emergency that has been a source of controversy in terms of terminology, phenomenology, and management since it was first described in 1982. Here we argue that the current use of the term status dystonicus falls well short of the precision needed for either clinical or academic use. We performed a critical review on this topic, describing possible pathophysiological mechanisms and areas of uncertainties. This review also addresses the problems derived by the extreme clinical heterogeneity of this condition, as the lack of an objective criterion useful for the definition, or the fact that status dystonicus may present not only in the context of a known dystonic syndrome. We propose a new possible definition that includes not only dystonia but also other hyperkinetic movements in the wide range of movement disorders that can be seen during an episode. The new definition keeps the term status dystonicus and highlights the fact that this is a medical emergency based on the impairment of bulbar and/or respiratory function requiring hospital admission as the principal feature. Furthermore, the new definition should not consider as necessary unspecific features as patient's condition at baseline, the distribution of dystonia, occurrence of systemic symptoms such as fever or laboratory findings. We hope that this proposal will stimulate the debate on this subject among our peers, further developing a clinical and pathophysiological understanding of status dystonicus. © 2017 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Marta Ruiz-Lopez
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Sobstyl M, Ząbek M, Kmieć T, Sławek J, Budohoski KP. Status dystonicus due to internal pulse generator depletion in a patient with primary generalized dystonia. Mov Disord 2013; 29:188-9. [PMID: 23868498 DOI: 10.1002/mds.25553] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 03/17/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Michał Sobstyl
- Department of Neurosurgery, Postgraduate Medical Center, Bródno Mazovia Hospital, Warsaw, Poland
| | | | | | | | | |
Collapse
|