Coming back to infections due to DBS: it really is relatedto the quality of
the surgeon; if you are very carefull during surgery there will be no
infections.

Out of 120 patients operated in our hospital in Ghent we did not have a
single case of electrode infection; only two cases of infection at the level
of the clavicle.  That's all. So the way the surgeon handles sterility is, I
believe the most imortant factor in calculating the risk of electrode
infection.

Chris van der Linden, M.D.
St. Lucas Hospital Ghent
Belgium




----- Original Message -----
From: "Murray Charters" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, March 20, 2002 1:31 PM
Subject: ARTICLE: Implant Patients May Suffer Infections, Hemorrhages


> The Charlotte Observer
> Posted on Tue, Mar. 19, 2002
>
> Implant patients may suffer infections, hemorrhages
> KAREN GARLOCH
> Staff Writer
>
> The risk of infection after brain surgery is one in 100,
> said Dr. Stephen Tatter, a neurosurgeon at
> Wake Forest University.
>
> But deep brain stimulation -- the new operation for
> Parkinson's disease symptoms -- is more risky because
> it involves implanting foreign objects. Electrodes are
> implanted deep in the brain. A stimulator goes in the
> chest near the collarbone. And a wire connects the two.
>
> Prior to approval by the federal Food and Drug
> Administration, a study of deep brain stimulation found
> that 17 of 160 enrolled patients, or 10.6 percent,
> experienced at least one device-related infection and
> several had more than one. In nine of the 17, the infection
> resulted in removal of at least part of the implant.
>
> In a separate study, reported in the New England Journal
> of Medicine in September, two of 143 patients had the
> implant removed because of infection.
>
> Tatter said three of his 100 patients who've had deep
> brain stimulation developed infections, including one
> who developed an infection twice.
>
> Charlotte patient Deborah Setzer, who had the surgery
> in December, was the first with an infection in the brain.
> The other infections had involved only the chest
> stimulator or the wire. Setzer's infection may have started
> at the stimulator in her chest and spread up the
> connecting wire, Tatter said. He removed her implants.
>
> Since Setzer's infection, Tatter has made changes.
>
> He's allowing fewer people in the operating room and less
> coming and going. He's also begun telling patients not
> to cut their own hair before surgery.
>
> Setzer had her head shaved by a beautician two days
> before surgery. She also shaved it again herself the day
> before.
>
> Tatter said he can't find studies documenting any
> connection between head shaving and infection risk.
> But as a resident at Massachusetts General Hospital
> in Boston, he learned that there was a higher risk
> of infection if patients' heads were shaved the night
> before surgery than if they were shaved that morning.
>
> "It's just better to be on the extra-cautious side," he said.
>
> The other major complication of deep brain stimulation
> is hemorrhage, or bleeding. In the study leading to FDA
> approval, 12 of 160 patients, or 7.5 percent, had intracranial
> hemorrhage. The study reported in the New England
> Journal said intracranial hemorrhage occurred in seven
> of 143 patients. Of those, two had the implant removed.
>
> Despite adverse side effects, the study concluded -- and
> many doctors agree -- that deep brain stimulation is safer
> than two decades-old operations for Parkinson's
> symptoms -- pallidotomy and thalamotomy. In those
> procedures, brain cells are destroyed to stop the signals
> that produce symptoms of pain, stiffness and tremor.
>
> Unlike those procedures, deep brain stimulation is
> reversible.
>
> "It's extremely safe," said Martin Bootin,
> a neurophysiologist at Presbyterian Hospital who
> consults on deep brain stimulation. "That's one
> of the reasons why it's received increased popularity
> over the previous surgery.
>
> "With these stimulators, you are causing far less
> permanent damage ... There's very low risk, and you
> have an increasing opportunity to optimize the
> treatment after the surgery."
>
> SOURCE: The Charlotte Observer
>
http://www.charlotte.com/mld/charlotte/living/columnists/karen_garloch/28888
46.htm
>
> * * *
>
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