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Management of a DBS system in patients with traumatic brain injury: case report

 Young Seok Park  ;  Joo pyung Kim  ;  Won Seok Chang  ;  Jin Woo Chang 
 NEUROMODULATION, Vol.14(3) : 214-218, 2011 
Journal Title
Issue Date
Accidents, Traffic ; Brain Injuries/pathology* ; Deep Brain Stimulation/methods* ; Electrodes, Implanted* ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Prosthesis Failure ; Subthalamic Nucleus/anatomy & histology ; Subthalamic Nucleus/physiology ; Subthalamic Nucleus/surgery ; Tomography, X-Ray Computed ; Tourette Syndrome/therapy ; Tremor/therapy ; Young Adult
Deep brain stimulation ; essential tremor ; Image fusion ; Tourette’s syndrome
INTRODUCTION:   The use of deep brain stimulation (DBS) is growing. While these patients may suffer from traumatic brain injuries, treatment guidelines for these patients have not yet been reported. This case report demonstrates a strategy for traumatic brain injury after DBS implantation.

CLINICAL PRESENTATION:   A 46-year-old man underwent bilateral DBS in the posterior subthalamic area for essential tremor, which improved both distal and proximal tremor. Two years later, he underwent emergent hematoma evacuation due to a motor vehicle associated injury. A 23-year-old male patient presented with severe Tourette's syndrome characterized by a vocal and self lip biting motor tic. There was a good effect of chronic bilateral thalamic DBS at CM-Pf. Five months later, he had acute subdural hematoma after a motorcycle accident. Instead of removing stimulation electrodes immediately after traumatic brain injury, the patient was reassessed after recovery. Merged preoperative magnetic resonance images and brain computed tomography images, and clinical reassessments were used to plan future treatment.

CONCLUSION:   We recommend removing only the hematoma, leaving the electrodes in position, and then reassessing the electrode position using merged images. The clinical correlation with electrode migration also should be checked. If the patient can tolerate stimulation with a minor displacement, the electrodes should be left in position and the stimulation parameter needs to be adjusted. If not, the stimulation electrodes should be deactivated or repositioned appropriately, depending on the patient's conditions
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Joo Pyung(김주평)
Park, Young Seok(박영석)
Chang, Won Seok(장원석) ORCID logo https://orcid.org/0000-0003-3145-4016
Chang, Jin Woo(장진우) ORCID logo https://orcid.org/0000-0002-2717-0101
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