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Ann-Christine Duhaime, Jill V. Hunter, Loretta L. Grate, Anje Kim, Jeffrey Golden, Eugene Demidenko and Christine Harris

Object. Whether the brain differs in its response to traumatic injury as a function of age remains unclear. To further investigate the age-dependent response of the brain to mechanical trauma, a cortical contusion model scaled for brain growth during maturation was used to study the evolution of injury over time as demonstrated on serial magnetic resonance (MR) imaging studies in piglets of different ages.

Methods. Sixteen Yorkshire piglets received scaled cortical contusions. Animals were either 5 days (six animals), 1 month (five animals), or 4 months (five animals) of age at injury. These ages correspond developmentally to human infants, toddlers, and early adolescents, respectively. Serial MR imaging examinations, including fluid-attenuated inversion-recovery and T1-, T2-, and diffusion-weighted sequences were performed at 24 hours, 1 week, and 1 month after injury. Lesions were quantified and expressed as a ratio of the lesion volume divided by the volume of the uninjured hemisphere for each animal and each MR sequencing. Differences in relative lesion volume among the varied ages at a single time point and in lesion volume over time at each age were compared. In addition, the relationship between age and evolution of injury were analyzed using a two-compartment mathematical model. Histological features were examined at 1 month postinjury. Despite comparable injury inputs, the youngest animals had lesions whose volumes peaked earlier and resolved more quickly than those in older animals. The intermediate-age piglets (toddler) had the most pronounced swelling of any age group, and the oldest piglets (adolescent) had the latest peak in lesion volume.

Conclusions. Scaled cortical contusions in piglets demonstrated age-dependent differences in injury response, both in magnitude and time course. These observations may shed light on development-related trauma response in the gyrencephalic brain.

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Christopher Kenney, Richard Simpson, Christine Hunter, William Ondo, Michael Almaguer, Anthony Davidson and Joseph Jankovic

Object

The object of this study was to assess the long-term safety of deep brain stimulation (DBS) in a large population of patients with a variety of movement disorders.

Methods

All patients treated with DBS at the authors' center between 1995 and 2005 were assessed for intraoperative, perioperative, and long-term adverse events (AEs).

A total of 319 patients underwent DBS device implantation. Of these 319, 182 suffered from medically refractory Parkinson disease; the other patients had essential tremor (112 patients), dystonia (19 patients), and other hyperkinetic movement disorders (six patients). Intraoperative AEs were rare and included vasovagal response in eight patients (2.5%), syncope in four (1.2%), severe cough in three (0.9%), transient ischemic attack in one (0.3%), arrhythmia in one (0.3%), and confusion in one (0.3%). Perioperative AEs included headache in 48 patients (15.0%), confusion in 16 (5.0%), and hallucinations in nine (2.8%). Serious intraoperative/perioperative AEs included isolated seizure in four patients (1.2%), intracerebral hemorrhage in two patients (0.6%), intraventricular hemorrhage in two patients (0.6%), and a large subdural hematoma in one patient (0.3%). Persistent long-term complications of DBS surgery included dysarthria (4.0%), worsening gait (3.8%), cognitive dysfunction (4.0%), and infection (4.4%). Revisions were completed in 25 patients (7.8%) for the following reasons: loss of effect, lack of efficacy, infection, lead fracture, and lead migration. Hardware-related complications included 12 lead fractuxres and 10 lead migrations.

Conclusions

The authors conclude that in their 10-year experience, DBS has proven to be safe for the treatment of medically refractory movement disorders.