Deep brain stimulation in two patients with immunosuppressive therapy
Conference Paper/Poster - Sep 11, 2020
Dorin Patrick, Walch Julia, Krüger Marie, Kägi Georg, Mittas Stephan, Bohlhalter Stephan, Hägele-Link Stefan, Brugger Florian
Deep brain stimulation (DBS) is a surgical procedure associated with a perioperative infection rate of approximately 1-2 %. Patients under immunosuppressive treatment are arguably more prone to infectious complications, but experience in patients on immunosuppressants who underwent DBS is limited to one anecdotal report (Samii et al. 2005).
The first patient has been treated with Mycofenolate-mofetil, Cortisone and Hydroxychloroquine for several years due to systemic lupus erythematosus. He received bilateral DBS in the ventral intermedius nucleus due to medication-refractory essential tremor. The second patient was under immunosuppressive therapy with Tacrolimus and Mycofenolate after renal transplant due to polycystic kidney disease. He suffered from Parkinson’s disease for >10 years. Due to pronounced wearing-offs and peak-dose dyskinesia he received bilateral DBS in the subthalamic nucleus.
The peri- and postoperative course in the first patient was favourable without any wound or lead infections. Three months after implantation an ischemic cerebral infarction of the small vessels occurred. A few months after implantation, the patient died from a septic shock due to aspiration pneumonia. Both events were considered as unrelated to DBS implantation. The second patient did not suffer from any peri- or postoperative wound or lead infections. Because of an infected hepatic cyst he developed a transient renal failure due to a bacteremia two weeks after surgery. However, the long-term outcome was favourable with a good recovery. Immunosuppressive therapy was continued in both patients.
In our two patients on immunosuppressive treatment we did not observe any wound or lead infections. Our observation is in line with one published case report on this topic, which did not show any perioperative complications either. However, the postoperative course was complicated by severe comorbidities. We consider DBS implantation in immunosuppressed patients as feasible, but multidisciplinary management is required. In order to provide more reliable evidence on this issue, systematic studies are warranted.