DBS-related infections in Parkinson's disease: Incidence, risk factors, management and outcome

BACKGROUND: Hardware-related infections may follow primary deep brain stimulation (DBS) implantation or implantable pulse generator (IPG) replacement with challenging management in fluctuating Parkinson's disease (PD) patients. OBJECTIVES: We aimed to investigate the incidence, risk factors, management and outcome of DBS-related infections in PD. METHODS: We performed a ten-year retrospective cohort study including all consecutive PD patients who underwent primary DBS implantation surgery and IPG replacement respectively. Incidence and risk factors of infections were analyzed in both cohorts using survival analysis, and infectious and neurological management was reported. RESULTS: The incidence of DBS-related infections was 11.3 (95%CI 6.3-18.7) per 1000 person-year following primary DBS implantation (293 patients) and 20.7 (95%CI 10.7-36.2) per 1000 person-year following IPG replacement (217 procedures in 188 patients). Infections were associated with a shorter disease duration before primary DBS implantation, but longer disease, DBS duration and a greater number of procedures for IPG replacement. Following DBS implantation, surgical management consisted in partial (3/15, 20%) or total (8/15, 53%) hardware removal, with good outcome in 12 (80%) patients. Infections resulted in increased short-term neurological worsening and challenging therapeutic management for total hardware removal and advanced PD patients. CONCLUSIONS: We found low incidence of DBS-related infections following primary DBS implantation or IPG replacement in PD patients, depending on PD duration. Our study highlights that patient-specific and multidisciplinary management in expert center resulted in good outcome and high rates of reimplantation following primary implantation-related infection, whereas PD patients with IPG replacement-associated infection had more severe outcome and challenging management.