Complications in the setting of device-aided therapies
Deep-brain stimulation | Levodopa-carbidopa intestinal gel | Apomorphine | |
Procedure | Surgery | Percutaneous endoscopy gastrostomy | Subcutaneous infusion |
Intracranial haemorrhage Venous infarction Pneumoencephalus Dyskinesia storm Air embolus | Pneumoperitoneum Peritonitis Gastrointestinal haemorrhage | Not described | |
Device | Hardware-related | Gastrointestinal pump | Pump |
Infection of external system Skin erosions at the level of the neurostimulator Fracture of extension wire End of life battery Accidental stimulator switch off (eg, environmental factors such as magnetic forces) | Breakdown of connexions Unintentional removal Obstruction of the intraduodenal tube (eg, kinking) Pressure ulcers of intraduodenal tube on intestinal wall Bezoar Pump dysfunction | Subcutaneous nodules Pump dysfunction | |
Treatment | Stimulation | Levodopa-carbidopa gel | Apomorphine |
Dyskinesia storm Gait unsteadiness Worsening of dysarthria Behavioural changes, hypomania, depression | Unpredictable offs Biphasic dyskinesias Confusion, hallucinations Malabsorption (B12, B6 vitamin deficiency), polyneuropathy, Guillain-Barré-like syndrome | Nauseas Hypotension Daytime somnolence Confusion, hallucinations Unpredictable offs Dyskinesias Haemolytic anaemia Eosinophilic syndrome |