Post DBS complications

Q: 74 years old male is admitted to ICU after insertion of subthalamic nucleus Deep Brain Stimulator (STN-DBS) for Parkinson's Disease (PD). A review of chart shows a strong psychiatric history. What would be your major concern in this patient? 

 Answer: Increased risk of suicide 

 Parkinson's Disease is usually associated with many psychiatric issues like anxiety, depression, hallucinations, and delusions. Patients with such associated symptoms may have an increased risk for suicide post-DBS implantation. Also, there is a high tendency for such patients to have a higher rate of transient confusion post-operatively. 

Other postoperative complications include infections, intracerebral hemorrhage (ICH), seizures, pulmonary embolism (PE), cerebrospinal fluid (CSF) leak, and venous infarction.

#neurology

#surgical-critical-care

#psychiatry

References:

1. Soulas T, Gurruchaga JM, Palfi S, et al. Attempted and completed suicides after subthalamic nucleus stimulation for Parkinson's disease. J Neurol Neurosurg Psychiatry 2008; 79:952. 

2. Voon V, Krack P, Lang AE, et al. A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson's disease. Brain 2008; 131:2720. 

3. Giannini G, Francois M, Lhommée E, et al. Suicide and suicide attempts after subthalamic nucleus stimulation in Parkinson disease. Neurology 2019; 93:e97. 

4. Kleiner-Fisman G, Herzog J, Fisman DN, et al. Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord 2006; 21 Suppl 14:S290. 

5. Pahwa R, Factor SA, Lyons KE, et al. Practice Parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006; 66:983.