BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNKNOWN IMPLANTABLE NEUROSTIMULATOR

    MDR report key: 4965646 · Received August 4, 2015

    Report

    Report Number
    3007566237-2015-02183
    Event Type
    Injury
    Date Received
    August 4, 2015
    Date of Event
    March 9, 2015
    Report Date
    July 8, 2015
    Manufacturer
    MEDTRONIC NEUROMODULATION
    Product Code
    MFR
    PMA / PMN Number
    H050003
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    RI, US
    Reporter Occupation
    HEALTH PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    PLEASE NOTE THAT THIS DATE IS BASED OFF OF THE DATE THAT THE ARTICLE WAS ACCEPTED FOR PUBLICATION AS THE EVENT DATES WERE NOT PROVIDED IN THE PUBLISHED LITERATURE. IT WAS NOT POSSIBLE TO ASCERTAIN SPECIFIC DEVICE INFORMATION FROM THE ARTICLE OR TO MATCH THE EVENTS REPORTED WITH PREVIOUSLY REPORTED EVENTS. CORRESPONDENCE HAS BEEN SENT TO THE AUTHOR OF THE ARTICLE INQUIRING ABOUT INDIVIDUAL PATIENT INFORMATION AND ADDITIONAL INFORMATION REGARDING THE REPORTED EVENTS. CONCOMITANT: PRODUCT ID 3389, PRODUCT TYPE LEAD. PRODUCT ID 3389, PRODUCT TYPE LEAD. (B)(4).

    Description of Event or Problem · 1

    SEGAR, D. J., CHODAKIEWITZ, Y. G., TORABI, R., COSGROVE, G. R. DEEP BRAIN STIMULATION FOR THE OBSESSIVE-COMPULSIVE AND TOURETTE-LIKE SYMPTOMS OF KLEEFSTRA SYNDROME. NEUROSURGICAL FOCUS. 2015; 38(6):E12. DOI: 10.3171/2015.3.FOCUS1528 SUMMARY: DEEP BRAIN STIMULATION (DBS) HAS BEEN REPORTED TO HAVE BENEFICIAL EFFECTS IN SEVERE, TREATMENT-REFRACTORY CASES OF OBSESSIV E-COMPULSIVE DISORDER (OCD) AND TOURETTE SYNDROME (TS). IN THIS REPORT, THE AUTHORS PRESENT THE FIRST CASE IN WHICH DBS WAS USED TO TREAT THE NEUROPSYCHIATRIC SYMPTOMS OF KLEEFSTRA SYNDROME, A RARE GENETIC DISORDER CHARACTERIZED BY CHILDHOOD HYPOTONIA, INTELLECTUAL DISABILITY, DISTINCTIVE FACIAL FEATURES, AND MYRIAD PSYCHIATRIC AND BEHAVIORAL DISTURBANCES. A (B)(6) FEMALE PATIENT WITH CHILDHOOD HYPOTONIA, DEVELOPMENTAL DELAY, AND DIAGNOSES OF AUTISM SPECTRUM DISORDER, OCD, AND TS REFRACTORY TO MEDICAL MANAGEMENT UNDERWENT THE PLACEMENT OF BILATERAL VENTRAL CAPSULE/VENTRAL STRIATUM (VC/VS) DBS LEADS, WITH CLINICAL IMPROVEMENT. MEDICAL PROVIDERS AND FAMILY OBSERVED GRADUAL AND PROGRESSIVE IMPROVEMENT IN THE PATIENT¿S COMPULSIVE BEHAVIORS, COPROLALIA, SPEECH, AND SOCIAL INTERACTION. SYMPTOMS RECURRED WHEN BOTH DBS ELECTRODES FAILED BECAUSE OF LEAD FRACTURE AND DISLODGEMENT, ALTHOUGH THE CLINICAL BENEFITS WERE RESTORED BY LEAD REPLACEMENT. THE SYMPTOMATIC AND FUNCTIONAL IMPROVEMENTS OBSERVED IN THIS CASE OF VC/VS DBS FOR KLEEFSTRA SYNDROME SUGGEST A NOVEL INDICATION FOR DBS WORTHY OF FURTHER INVESTIGATION. REPORTED EVENT ONE (B)(6) FEMALE PATIENT UNDERWENT BILATERAL VENTRAL CAPSULE/VENTRAL STRIATUM (VC/VS) DEEP BRAIN STIMULATION (DBS) IMPLANT TO TREAT DISABLING OBSESSIVE-COMPULSIVE DISORDER (OCD) AND TOURETTE SYNDROME (TS), WHICH WERE DUE TO KLEEFSTRA SYNDROME. CORRECT IMPLANTATION WAS CONFIRMED USING POSTOPERATIVE CT STUDIES MERGED WITH PREOPERATIVE MRI. AFTER IMPLANTATION, THE PATIENT DEMONSTRATED GRADUAL AND PROGRESSIVE IMPROVEMENT IN HER OBSESSIVE-COMPULSIVE BEHAVIORS, COPROLALIA, SPEECH, AND SOCIAL INTERACTION OVER 3-9 MONTHS. HER GLOBAL ASSESSMENT OF FUNCTIONING (GAF) SCORES IMPROVED STEADILY DURING THIS TIME, JUMPING TO 30-40 SHORTLY AFTER IMPLANTATION AND INCREASING TO 50-60 AFTER NINE MONTHS. SHE THEN BEGAN TO GRADUALLY REGRESS CLINICALLY OVER SEVERAL MONTHS WITH NOTED WORSENING OF SYMPTOMS. IMAGING REVEALED THE LEFT LEAD HAD FRACTURED AND THE RIGHT LEAD HAD WITHDRAWN FROM THE TARGET. THE REPORTER STATED THAT IT WAS LIKELY THAT BOTH OF THESE EVENTS RESULTED FROM INADEQUATE ANCHORING OF THE CONNECTORS, WHICH CAUSED DOWNWARD MIGRATION FROM THEIR INITIAL POSITIONS ON THE PATIENT¿S SKULL. BY THIS TIME, HER GAF SCORE HAD RETURNED TO A BASELINE OF 20. BOTH LEADS WERE SUBSEQUENTLY EXPLANTED. BECAUSE MEDICAL PROVIDERS, TEACHERS, CAREGIVERS, AND FAMILY CORROBORATED THAT DBS HAD DRAMATICALLY IMPROVED THE PATIENT¿S FUNCTION, THE LEADS WERE REPLACED IN THEIR ORIGINAL LOCATIONS IN THE VC/VS. IMPLANTATION WAS AGAIN CONFIRMED WITH POSTOPERATIVE CT STUDIES MERGED WITH PREOPERATIVE MRI. FOLLOWING LEAD REPLACEMENT, THE PATIENT ONCE AGAIN BEGAN TO EXPERIENCE SUBSTANTIAL IMPROVEMENT, WITH A SIMILAR INCREASE IN GAF SCORES TO BETWEEN 50 AND 60. SHE BECAME MORE COMMUNICATIVE AND INTERACTIVE AT SCHOOL, AN IMPROVEMENT THAT WAS NOTED BY CLINICIANS, FAMILY MEMBERS, TEACHERS, OTHER PARENTS, AND STUDENTS. SHE BECAME SIGNIFICANTLY MORE INTERACTIVE AND MOTIVATED DURING DAILY ACTIVITIES AND EVEN PARTICIPATED IN SPECIAL OLYMPICS BOWLING. CARE PROVIDERS ALSO NOTED A SIGNIFICANT REDUCTION IN HER ANXIETY, COMPULSIVE BEHAVIORS, COPROLALIA, AND VOCAL TICS. HER HYPERPHAGIC TENDENCIES ALSO DECREASED, CONTRIBUTING TO A NEARLY 20-KG WEIGHT LOSS. DESPITE THE OBSERVATION THAT SOME PATIENTS WITH KLEEFSTRA SYNDROME DEMONSTRATE A REGRESSIVE COURSE WITH WORSENING MOTOR AND NEUROBEHAVIORAL SYMPTOMS OVER TIME, THE PATIENT CONTINUED TO FUNCTION SUBSTANTIALLY ABOVE HER BASELINE LEVEL MORE THAN THREE YEARS AFTER REPLACEMENT OF THE DBS LEADS. A CONSIDERABLE REDUCTION IN OCD BEHAVIORS ALLOWED FOR SUBSTANTIAL QUALITATIVE BENEFITS TO THE PATIENT AND HER FAMILY. THE SOURCE LITERATURE INCLUDED THE FOLLOWING DEVICE SPECIFICS: LEAD MODEL 3389 FURTHER INFORMATION HAS BEEN REQUESTED; A SUPPLEMENTAL REPORT WILL BE SUBMITTED IF ADDITIONAL INFORMATION IS RECEIVED.

    Description of Event or Problem · 1

    ADDITIONAL INFORMATION RECEIVED REPORTED THAT THE BREAKAGE OF THE LEAD AND THE MIGRATION OF THE SECOND LEAD WAS NOT RELATED TO MANUFACTURER ERROR OR DEVICE MALFUNCTION; THE REPORTER STATED THAT THE IMPLANTING SURGEON HAD PLACED MINERAL OIL ON THE ELECTRODE TO HELP IT SLIDE THROUGH THE GUIDE CANNULA AND THE TARGETING DEVICE. THIS REPORTEDLY PREVENTED FIRM FIXATION AT THE STIMLOCK. IT WAS ALSO NOTED THAT THE CONNECTION OF THE ELECTRODE TO THE EXTENSION CABLE WAS NEVER SECURED TO THE PERIOSTEUM BEHIND THE EAR AND THIS ALLOWED FOR MIGRATION OVER TIME WITH NECK MOVEMENTS. AFTER REMOVING BOTH FAILED ELECTRODES, TWO NEW ELECTRODES WERE IMPLANTED AND SECURED TO THE APPROPRIATE TARGET. THERE HAD BEEN NO PROBLEM WITH EITHER OF THESE NEWLY IMPLANTED ELECTRODES OR THE BATTERY SINCE RE-IMPLANTATION OF THE NEW SYSTEM USING THIS SURGICAL TECHNIQUE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    507970 UNKNOWN IMPLANTABLE NEUROSTIMULATOR MFR MEDTRONIC NEUROMODULATION NEU_INS_STIMULATOR UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 00024 YR Required Intervention