Document Type : Short Communication

Authors

1 Department of Neurology, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

2 Department of Clinical Neurosciences, Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy

3 Department of Internal Medicine, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

4 Department of Neurosurgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

5 Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran

6 Department of Neurology, Rasoul-e Akram Hospital, Iran University of Medical Science, Tehran, Iran

Abstract

Background: Nowadays, many neurological conditions, including Parkinson’s disease (PD), are treated with deep brain stimulation (DBS). Life-threatening consequences can occur from DBS hardware failure or sudden implantable pulse generator (IPG) battery depletion. This issue may potentially worsen in concomitance with medical or infectious conditions, requiring stronger emergency management.
Methods: We present here a 58 year-old PD patient with DBS, whose IPG replacement surgery was complicated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and we report management of this patient along with recommendations for patients with similar situation.
Results: As the newly-emerged coronavirus disease 2019 (COVID-19) is now announced to be pandemic, new protocols and specific measures for each individual group of patients with chronic diseases seem obligatory. Regarding our recent experience with a patient suffering from PD, on DBS treatment, who needed hospitalization, we felt useful to share our experience as a recommended protocol for similar patients in the time of current pandemic.
Conclusion: Close monitoring of laboratory and clinical signs should be warranted in patients with PD awaiting IPG replacement in order to be prepared in these novel conditions that may precipitate an akinetic crisis/dystonic storm and to prevent life-threatening complications during the current pandemic.

Keywords

  1. Cossu G, Sensi M. Deep brain stimulation emergencies: How the new technologies could modify the current scenario. Curr Neurol Neurosci Rep 2017; 17(7): 51.
  2. Hamed M, Ba F, Suchowersky O, Sankar T. Depleting implanted pulse generator (IPG) battery voltage is associated with worsening clinical symptoms in movement disorder patients receiving deep brain stimulation (DBS). Clinical Parkinsonism and Related Disorders 2019; 1: 98-9.
  3. Hariz MI, Johansson F. Hardware failure in parkinsonian patients with chronic subthalamic nucleus stimulation is a medical emergency. Mov Disord 2001; 16(1): 166-8.
  4. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382(8): 727-33.
  5. Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol 2020; 92(6): 552-5.
  6. Holla VV, Neeraja K, Surisetti BK, Prasad S, Kamble N, Srinivas D, et al. Deep brain stimulation battery exhaustion during the COVID-19 pandemic: Crisis within a crisis. J Mov Disord 2020; 13(3): 218-22.
  7. Fasano A, Elia AE, Dallocchio C, Canesi M, Alimonti D, Sorbera C, et al. Predictors of COVID-19 outcome in Parkinson's disease. Parkinsonism Relat Disord 2020; 78: 134-7.