Deep brain stimulation in critical care conditions

Area of Science:

• Neurosurgery
• Neurology
• Intensive Care Medicine

Background:

• Neurological conditions requiring intensive care unit (ICU) admission often involve deep sedation and mechanical ventilation.
• These intensive care procedures are not always effective in controlling critical neurological conditions.
• Deep brain stimulation (DBS) presents a potential alternative for managing severe neurological conditions.

Purpose of the Study:

• To investigate the efficacy and safety of DBS as an emergency procedure for critical neurological conditions in the neurological ICU (NICU).
• To evaluate DBS for status dystonicus (SD) and post-stroke hemiballismus.
• To assess the long-term clinical benefit of DBS in acute, life-threatening neurological emergencies.

Main Methods:

• A before-and-after perspective study involving seven patients treated with DBS.
• Bilateral globus pallidus internus (GPi) DBS for five patients with SD.
• Unilateral ventralis oralis anterior and posterior (Voa/Vop) nucleus of the thalamus DBS for two patients with post-stroke hemiballismus.

Main Results:

• Bilateral GPi-DBS resolved SD within 1 week to 3 months, with no significant baseline clinical improvement observed.
• Unilateral Voa/Vop-DBS controlled hemiballismus within 10 hours in one patient, leading to discharge in 2 days.
• No surgical complications were reported in any of the procedures.

Conclusions:

• Neurostimulation, specifically DBS, is a viable option for critical care patients with continuous, life-threatening involuntary movements refractory to standard intensive care.
• DBS is demonstrated to be feasible, safe, and effective in selected critical neurological cases.
• Emergency DBS implantation may offer significant benefits in specific neurological emergencies.