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Deer TR, Russo MA, Sayed D, Pope JE, Grider JS, Hagedorn JM, Falowski SM, Al-Kaisy A, Slavin KV, Li S, Poree LR, Eldabe S, Meier K, Lamer TJ, Pilitsis JG, De Andrés J, Perruchoud C, Carayannopoulos AG, Moeschler SM, Hadanny A, Lee E, Varshney VP, Desai MJ, Pahapill P, Osborn J, Bojanic S, Antony A, Piedimonte F, Hayek SM, Levy RM. The Neurostimulation Appropriateness Consensus Committee (NACC)®: Recommendations for the Mitigation of Complications of Neurostimulation. Neuromodulation 2024; 27:977-1007. [PMID: 38878054 DOI: 10.1016/j.neurom.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION The International Neuromodulation Society convened a multispecialty group of physicians based on expertise and international representation to establish evidence-based guidance on the mitigation of neuromodulation complications. This Neurostimulation Appropriateness Consensus Committee (NACC)® project intends to update evidence-based guidance and offer expert opinion that will improve efficacy and safety. MATERIALS AND METHODS Authors were chosen on the basis of their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from 2017 (when NACC last published guidelines) to October 2023. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on the strength of evidence or consensus when evidence was scant. RESULTS The NACC examined the published literature and established evidence- and consensus-based recommendations to guide best practices. Additional guidance will occur as new evidence is developed in future iterations of this process. CONCLUSIONS The NACC recommends best practices regarding the mitigation of complications associated with neurostimulation to improve safety and efficacy. The evidence- and consensus-based recommendations should be used as a guide to assist decision-making when clinically appropriate.
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Affiliation(s)
- Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA.
| | | | - Dawood Sayed
- The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Jay S Grider
- UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Adnan Al-Kaisy
- Guy's and St. Thomas National Health Service (NHS) Foundation Trust, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA; Neurology Section, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA
| | - Sean Li
- National Spine & Pain Centers, Shrewsbury, NJ, USA
| | - Lawrence R Poree
- Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA, USA
| | - Sam Eldabe
- The James Cook University Hospital, Middlesbrough, UK
| | - Kaare Meier
- Department of Anesthesiology (OPINord), Aarhus University Hospital, Aarhus, Arhus, Denmark; Department of Neurosurgery (Afd. NK), Aarhus University Hospital, Aarhus, Arhus, Denmark
| | | | | | - Jose De Andrés
- Valencia School of Medicine, Anesthesia Critical Care and Pain Management Department, General University Hospital, Valencia, Spain
| | | | - Alexios G Carayannopoulos
- Department of Physical Medicine and Rehabilitation and Comprehensive Spine Center, Rhode Island Hospital, Providence, RI, USA; Brown University Warren Alpert Medical School (Neurosurgery), Providence, RI, USA
| | - Susan M Moeschler
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amir Hadanny
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Eric Lee
- Mililani Pain Center, Mililani, HI, USA
| | - Vishal P Varshney
- Anesthesiology and Pain Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mehul J Desai
- International Spine, Pain & Performance Center, Virginia Hospital Center, Monument Research Institute, George Washington University School of Medicine, Arlington, VA, USA
| | - Peter Pahapill
- Functional Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Osborn
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Stana Bojanic
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ajay Antony
- The Orthopaedic Institute, Gainesville, FL, USA
| | - Fabian Piedimonte
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Salim M Hayek
- Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH, USA
| | - Robert M Levy
- Neurosurgical Services, Clinical Research, Anesthesia Pain Care Consultants, Tamarac, FL, USA
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Paterson A, Kumaria A, Sitaraman M, Sabbubeh T, Ingale H, Basu S. Dissection using pulsed radiofrequency energy device (PlasmaBlade) is safe and efficient in experimental revision neuromodulation implant surgery. Br J Neurosurg 2024; 38:439-446. [PMID: 33621158 DOI: 10.1080/02688697.2021.1885622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/22/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The use of functional neurosurgical implants has increased over the past 10 years. PlasmaBlade is an innovative electrosurgical appliance harnessing pulsed radiofrequency (RF) energy. Our aim was to assess the risk of damage to neuromodulation hardware during PlasmaBlade dissection. MATERIALS AND METHODS A simulated setting with chicken breast threaded with different hardware and PlasmaBlade used in three configurations. . Post dissection, the wires were inspected naked eye and under an operating microscope. The induced current was assessed contemporaneously using an oscilloscope. RESULTS Five surgeons tested the PlasmaBlade at different generator settings. Sixty dissections were undertaken. No structural damage or induced current was identified at CUT 3/4, COAG 5. At CUT 6, COAG 5 and during dissection in a perpendicular orientation with prolonged hardware contact, opacification of insulation material occurred in 15/20 dissections. There was no dissolution of insulation even at this setting. On deviation from Medtronic advice, hardware damaged occurred if one was reckless with the PlasmaBlade. CONCLUSION When using the recommended settings and operational technique, PlasmaBlade dissection did not cause any damage to implant wiring/tubing in this simulated setting. This report seeks to add to clinical data suggesting PlasmaBlade is safe for dissection around deep brain stimulator (DBS), vagal nerve stimulator (VNS), and spinal cord stimulator (SCS) hardware.
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Affiliation(s)
- Alistair Paterson
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Ashwin Kumaria
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Murugan Sitaraman
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Thabit Sabbubeh
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Harshal Ingale
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Surajit Basu
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
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Vöröslakos M, Yaghmazadeh O, Alon L, Sodickson DK, Buzsáki G. Brain-implanted conductors amplify radiofrequency fields in rodents: Advantages and risks. Bioelectromagnetics 2024; 45:139-155. [PMID: 37876116 PMCID: PMC10947979 DOI: 10.1002/bem.22489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 07/26/2023] [Accepted: 09/30/2023] [Indexed: 10/26/2023]
Abstract
Over the past few decades, daily exposure to radiofrequency (RF) fields has been increasing due to the rapid development of wireless and medical imaging technologies. Under extreme circumstances, exposure to very strong RF energy can lead to heating of body tissue, even resulting in tissue injury. The presence of implanted devices, moreover, can amplify RF effects on surrounding tissue. Therefore, it is important to understand the interactions of RF fields with tissue in the presence of implants, in order to establish appropriate wireless safety protocols, and also to extend the benefits of medical imaging to increasing numbers of people with implanted medical devices. This study explored the neurological effects of RF exposure in rodents implanted with neuronal recording electrodes. We exposed freely moving and anesthetized rats and mice to 950 MHz RF energy while monitoring their brain activity, temperature, and behavior. We found that RF exposure could induce fast onset firing of single neurons without heat injury. In addition, brain implants enhanced the effect of RF stimulation resulting in reversible behavioral changes. Using an optical temperature measurement system, we found greater than tenfold increase in brain temperature in the vicinity of the implant. On the one hand, our results underline the importance of careful safety assessment for brain-implanted devices, but on the other hand, we also show that metal implants may be used for neurostimulation if brain temperature can be kept within safe limits.
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Affiliation(s)
- Mihály Vöröslakos
- Neuroscience Institute, Langone Medical Center, New York University, New York, NY 10016, USA
| | - Omid Yaghmazadeh
- Neuroscience Institute, Langone Medical Center, New York University, New York, NY 10016, USA
| | - Leeor Alon
- Department of Radiology, Grossman School of Medicine, New York University, New York, NY 10016, USA
| | - Daniel K. Sodickson
- Neuroscience Institute, Langone Medical Center, New York University, New York, NY 10016, USA; Department of Radiology, Grossman School of Medicine, New York University, New York, NY 10016, USA
| | - György Buzsáki
- Neuroscience Institute, Langone Medical Center, New York University, New York, NY 10016, USA; Department of Neurology, Grossman School of Medicine, New York University, New York, NY 10016, USA
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Esplin N, Kusyk D, Jeong SW, Elhamdani S, Abdel Aziz K, Webb A, Angle C, Whiting D, Tomycz ND. Movement disorder Deep brain stimulation Hybridization: Patient and caregiver outcomes. Clin Park Relat Disord 2024; 10:100234. [PMID: 38292816 PMCID: PMC10827541 DOI: 10.1016/j.prdoa.2024.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 11/11/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Deep brain stimulation (DBS) is a well-established surgical treatment for certain movement disorders and involves the implantation of brain electrodes connected to implantable pulse generators (IPGs). As more device manufacturers have entered the market, some IPG technology has been designed to be compatible with brain electrodes from other manufacturers, which has facilitated the hybridization of implant technology. The aim of this study was to assess the benefits of hybridization of non-rechargeable, constant voltage IPGs to rechargeable, constant current IPGs. Methods A list of DBS movement disorder patients who had their non-rechargeable, constant voltage IPGs replaced with rechargeable, constant current IPGs from a different manufacturer was compiled. Structured surveys of these patients, and their caregivers when applicable, were undertaken to determine both patient and caregiver satisfaction in this DBS hybridization strategy. Results Eighteen patients met inclusion criteria and twelve patients or their caregivers completed the structured survey (67% response rate). Nine patients had Parkinson's disease (75%), three had essential tremor (25%). Nine (75%) were converted from bilateral single-channel IPGs, and three (25%) were converted from a unilateral dual-channel IPGs. Overall, 92% of patients and caregivers surveyed reported improvement or no change in their symptoms, 92% reported a decrease or no change in their medication requirements, and 92% report they are satisfied or very satisfied with their IPG hybridization and would recommend the surgery to similar patients. There were no immediate surgical complications. Conclusion In this series of movement disorder DBS patients, surgery was safe and patient and caregiver satisfaction were high with a hybridization of non-rechargeable, constant voltage IPGs to rechargeable, constant current IPGs.
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Affiliation(s)
- Nathan Esplin
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Dorian Kusyk
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Seung W Jeong
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Shahed Elhamdani
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Khaled Abdel Aziz
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Amanda Webb
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Cindy Angle
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Donald Whiting
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Nestor D. Tomycz
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
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Balachandar A, Boutet A, Vetkas A, Germann J, Chan IY, Mikulis D, Munhoz RP, Fasano A, Kalia SK, Lozano AM. The Role of Safe MRI in Diagnosing an Unusual Case of High-Grade Glioma Adjacent to Globus Pallidus Interna DBS Electrode. Mov Disord Clin Pract 2023; 10:138-140. [PMID: 36704068 PMCID: PMC9847298 DOI: 10.1002/mdc3.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 01/29/2023] Open
Affiliation(s)
- Arjun Balachandar
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Alexandre Boutet
- Joint Department of Medical ImagingUniversity of TorontoTorontoOntarioCanada
| | - Artur Vetkas
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
| | - Jurgen Germann
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
| | - Ian Y.M. Chan
- Joint Department of Medical ImagingUniversity of TorontoTorontoOntarioCanada
| | - David Mikulis
- Joint Department of Medical ImagingUniversity of TorontoTorontoOntarioCanada
| | - Renato P. Munhoz
- Krembil Research InstituteTorontoOntarioCanada
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
| | - Alfonso Fasano
- Krembil Research InstituteTorontoOntarioCanada
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
| | - Suneil K. Kalia
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
| | - Andres M. Lozano
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
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Lundstrom BN, Lin C, Starnes DK, Middlebrooks EH, Tatum W, Grewal SS, Crepeau AZ, Gregg NM, Miller KJ, Van Gompel JJ, Watson RE. Safety and Management of Implanted Epilepsy Devices for Imaging and Surgery. Mayo Clin Proc 2022; 97:2123-2138. [PMID: 36210199 PMCID: PMC9888397 DOI: 10.1016/j.mayocp.2022.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/13/2022] [Accepted: 06/13/2022] [Indexed: 11/05/2022]
Abstract
Permanently implanted devices that deliver electrical stimulation are increasingly used to treat patients with drug-resistant epilepsy. Primary care physicians, neurologists, and epilepsy clinicians may encounter patients with a variety of implanted neuromodulation devices in the course of clinical care. Due to the rapidly changing landscape of available epilepsy-related neurostimulators, there may be uncertainty related to how these devices should be handled during imaging procedures and perioperative care. We review the safety and management of epilepsy-related implanted neurostimulators that may be encountered during imaging and surgery. We provide a summary of approved device labeling and recommendations for the practical management of these devices to help guide clinicians as they care for patients treated with bioelectronic medicine.
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Affiliation(s)
| | - Chen Lin
- Department of Radiology, Mayo Clinic, Jacksonville, FL
| | | | | | - William Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL
| | | | - Amy Z Crepeau
- Department of Neurology, Mayo Clinic, Scottsdale, AZ
| | | | - Kai J Miller
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
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7
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Ruan H, Wang Y, Li Z, Tong G, Wang Z. A Systematic Review of Treatment Outcome Predictors in Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder. Brain Sci 2022; 12:brainsci12070936. [PMID: 35884742 PMCID: PMC9316868 DOI: 10.3390/brainsci12070936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/06/2022] [Accepted: 07/15/2022] [Indexed: 12/04/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a chronic and debilitating mental disorder. Deep brain stimulation (DBS) is a promising approach for refractory OCD patients. Research aiming at treatment outcome prediction is vital to provide optimized treatments for different patients. The primary purpose of this systematic review was to collect and synthesize studies on outcome prediction of OCD patients with DBS implantations in recent years. This systematic review (PROSPERO registration number: CRD42022335585) followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) guidelines. The search was conducted using three different databases with the following search terms related to OCD and DBS. We identified a total of 3814 articles, and 17 studies were included in our review. A specific tract confirmed by magnetic resonance imaging (MRI) was predictable for DBS outcome regardless of implant targets, but inconsistencies still exist. Current studies showed various ways of successful treatment prediction. However, considering the heterogeneous results, we hope that future studies will use larger cohorts and more precise approaches for predictors and establish more personalized ways of DBS surgeries.
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Affiliation(s)
- Hanyang Ruan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China; (H.R.); (Y.W.); (Z.L.); (G.T.)
| | - Yang Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China; (H.R.); (Y.W.); (Z.L.); (G.T.)
| | - Zheqin Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China; (H.R.); (Y.W.); (Z.L.); (G.T.)
| | - Geya Tong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China; (H.R.); (Y.W.); (Z.L.); (G.T.)
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China; (H.R.); (Y.W.); (Z.L.); (G.T.)
- Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai 200030, China
- Shanghai Key Laboratory of Psychotic Disorders (No. 13dz2260500), Shanghai 200030, China
- Correspondence: ; Tel.: +86-180-1731-1286
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Kosten L, Emmi SA, Missault S, Keliris GA. Combining magnetic resonance imaging with readout and/or perturbation of neural activity in animal models: Advantages and pitfalls. Front Neurosci 2022; 16:938665. [PMID: 35911983 PMCID: PMC9334914 DOI: 10.3389/fnins.2022.938665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
One of the main challenges in brain research is to link all aspects of brain function: on a cellular, systemic, and functional level. Multimodal neuroimaging methodology provides a continuously evolving platform. Being able to combine calcium imaging, optogenetics, electrophysiology, chemogenetics, and functional magnetic resonance imaging (fMRI) as part of the numerous efforts on brain functional mapping, we have a unique opportunity to better understand brain function. This review will focus on the developments in application of these tools within fMRI studies and highlight the challenges and choices neurosciences face when designing multimodal experiments.
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Affiliation(s)
- Lauren Kosten
- Bio-Imaging Lab, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Serena Alexa Emmi
- Bio-Imaging Lab, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Stephan Missault
- Bio-Imaging Lab, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Georgios A. Keliris
- Bio-Imaging Lab, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
- Foundation for Research & Technology – Hellas, Heraklion, Greece
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Yaghmazadeh O, Vöröslakos M, Alon L, Carluccio G, Collins C, Sodickson DK, Buzsáki G. Neuronal activity under transcranial radio-frequency stimulation in metal-free rodent brains in-vivo. COMMUNICATIONS ENGINEERING 2022; 1:15. [PMID: 38125336 PMCID: PMC10732550 DOI: 10.1038/s44172-022-00014-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/08/2022] [Indexed: 12/23/2023]
Abstract
As the use of Radio Frequency (RF) technologies increases, the impact of RF radiation on neurological function continues to receive attention. Whether RF radiation can modulate ongoing neuronal activity by non-thermal mechanisms has been debated for decades. However, the interactions between radiated energy and metal-based neural probes during experimentation could impact neural activity, making interpretation of the results difficult. To address this problem, we modified a miniature 1-photon Ca2+ imaging device to record interference-free neural activity and compared the results to those acquired using metal-containing silicon probes. We monitored the neuronal activity of awake rodent-brains under RF energy exposure (at 950 MHz) and in sham control paradigms. Spiking activity was reliably affected by RF energy in metal containing systems. However, we did not observe neuronal responses using metal-free optical recordings at induced local electric field strengths up to 230 V/m. Our results suggest that RF exposure higher than levels that are allowed by regulatory limits in real-life scenarios do not affect neuronal activity.
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Affiliation(s)
- Omid Yaghmazadeh
- Neuroscience Institute, School of Medicine, New York University, New York, NY 10016, USA
- These authors contributed equally: Omid Yaghmazadeh, Mihály Vöröslakos
| | - Mihály Vöröslakos
- Neuroscience Institute, School of Medicine, New York University, New York, NY 10016, USA
- These authors contributed equally: Omid Yaghmazadeh, Mihály Vöröslakos
| | - Leeor Alon
- Department of Radiology, School of Medicine, New York University, New York, NY 10016, USA
| | - Giuseppe Carluccio
- Department of Radiology, School of Medicine, New York University, New York, NY 10016, USA
| | - Christopher Collins
- Department of Radiology, School of Medicine, New York University, New York, NY 10016, USA
| | - Daniel K. Sodickson
- Neuroscience Institute, School of Medicine, New York University, New York, NY 10016, USA
- Department of Radiology, School of Medicine, New York University, New York, NY 10016, USA
| | - György Buzsáki
- Neuroscience Institute, School of Medicine, New York University, New York, NY 10016, USA
- Department of Neurology, School of Medicine, New York University, New York, NY 10016, USA
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Loh A, Boutet A, Chow CT, Elias GJB, Germann J, Kucharczyk W, Lozano AM. Letter: Unforeseen Hurdles Associated With Magnetic Resonance Imaging in Patients With Deep Brain Stimulation Devices. Neurosurgery 2022; 90:e129. [PMID: 35199650 DOI: 10.1227/neu.0000000000001887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Clement T Chow
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Walter Kucharczyk
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
- Krembil Research Institute, Toronto, Canada
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11
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Bhusal B, Bhattacharyya P, Baig T, Jones S, Martens M. Effect of inter-electrode RF coupling on heating patterns of wire-like conducting implants in MRI. Magn Reson Med 2022; 87:2933-2946. [PMID: 35092097 DOI: 10.1002/mrm.29177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/16/2021] [Accepted: 01/09/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE In this study, the effects of RF coupling on the magnitude and spatial patterns of RF-induced heating near multiple wire-like conducting implants (such as simultaneous electrical stimulation of stereoelectroencephalography electrodes) during MRI were assessed. METHODS Simulations and experimental measurements of RF-induced temperature increases near partially immersed wire-like conductors were performed using a phantom with a transmit/receive head coil on a 3T MRI system. The conductors consisted of either a pair of wires or a single simultaneous electrical stimulation of stereoelectroencephalography electrode with multiple contacts, and the locations and lengths of the conductors were varied to study the effect of electromagnetic coupling on RF-induced heating. RESULTS The temperature increase near a wire within the phantom was dependent not only on its own location and length, but also on the locations and lengths of the other partially immersed wires. In the configurations that were studied, the presence of a second implant could increase the heating near the tip of the conductor by as much as 95%. CONCLUSION The level of RF-induced heating during an MR scan is affected significantly by RF coupling when more than one wire-like implant is present. In some of the configurations studied, the heating was increased by the presence of a second conductor partially immersed in the phantom. Thus, RF coupling is an important factor to consider in the assessment of safety issues for MRI when multiple implants are present.
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Affiliation(s)
- Bhumi Bhusal
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | | | - Tanvir Baig
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stephen Jones
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Martens
- Department of Physics, Case Western Reserve University, Cleveland, Ohio, USA
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12
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Derksen M, Rhemrev V, van der Veer M, Jolink L, Zuidinga B, Mulder T, Reneman L, Nederveen A, Feenstra M, Willuhn I, Denys D. Animal studies in clinical MRI scanners: A custom setup for combined fMRI and deep-brain stimulation in awake rats. J Neurosci Methods 2021; 360:109240. [PMID: 34097929 DOI: 10.1016/j.jneumeth.2021.109240] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 03/30/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In humans, functional magnetic resonance imaging (fMRI) cannot be used to its full potential to study the effects of deep-brain stimulation (DBS) on the brain due to safety reasons. Application of DBS in small animals is an alternative, but was hampered by technical limitations thus far. NEW METHOD We present a novel setup that extends the range of available applications by studying animals in a clinical scanner. We used a 3 T-MRI scanner with a custom-designed receiver coil and a restrainer to measure brain activity in awake rats. DBS electrodes made of silver were used to minimize electromagnetic artifacts. Before scanning, rats were habituated to the restrainer. RESULTS Using our novel setup, we observed minor DBS-electrode artifacts, which did not interfere with brain-activity measurements significantly. Movement artifacts were also minimal and were not further reduced by restrainer habituation. Bilateral DBS in the dorsal part of the ventral striatum (dVS) resulted in detectable increases in brain activity around the electrodes tips. COMPARISON WITH EXISTING METHODS This novel setup offers a low-cost alternative to dedicated small-animal scanners. Moreover, it can be implemented in widely available clinical 3 T scanners. Although spatial and temporal resolution was lower than what is achieved in anesthetized rats in high-field small-animal scanners, we obtained scans in awake animals, thus, testing the effects of bilateral DBS of the dVS in a more physiological state. CONCLUSIONS With this new technical setup, the neurobiological mechanism of action of DBS can be explored in awake, restrained rats in a clinical 3 T-MRI scanner.
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Affiliation(s)
- Maik Derksen
- The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Valerie Rhemrev
- The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Marijke van der Veer
- The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Linda Jolink
- The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Birte Zuidinga
- The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Tosca Mulder
- The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Liesbeth Reneman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Aart Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Matthijs Feenstra
- The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Ingo Willuhn
- The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Amsterdam, the Netherlands.
| | - Damiaan Denys
- The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Amsterdam, the Netherlands
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13
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McGlynn E, Nabaei V, Ren E, Galeote‐Checa G, Das R, Curia G, Heidari H. The Future of Neuroscience: Flexible and Wireless Implantable Neural Electronics. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:2002693. [PMID: 34026431 PMCID: PMC8132070 DOI: 10.1002/advs.202002693] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/15/2021] [Indexed: 05/04/2023]
Abstract
Neurological diseases are a prevalent cause of global mortality and are of growing concern when considering an ageing global population. Traditional treatments are accompanied by serious side effects including repeated treatment sessions, invasive surgeries, or infections. For example, in the case of deep brain stimulation, large, stiff, and battery powered neural probes recruit thousands of neurons with each pulse, and can invoke a vigorous immune response. This paper presents challenges in engineering and neuroscience in developing miniaturized and biointegrated alternatives, in the form of microelectrode probes. Progress in design and topology of neural implants has shifted the goal post toward highly specific recording and stimulation, targeting small groups of neurons and reducing the foreign body response with biomimetic design principles. Implantable device design recommendations, fabrication techniques, and clinical evaluation of the impact flexible, integrated probes will have on the treatment of neurological disorders are provided in this report. The choice of biocompatible material dictates fabrication techniques as novel methods reduce the complexity of manufacture. Wireless power, the final hurdle to truly implantable neural interfaces, is discussed. These aspects are the driving force behind continued research: significant breakthroughs in any one of these areas will revolutionize the treatment of neurological disorders.
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Affiliation(s)
- Eve McGlynn
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Vahid Nabaei
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Elisa Ren
- Laboratory of Experimental Electroencephalography and NeurophysiologyDepartment of BiomedicalMetabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModena41125Italy
| | - Gabriel Galeote‐Checa
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Rupam Das
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Giulia Curia
- Laboratory of Experimental Electroencephalography and NeurophysiologyDepartment of BiomedicalMetabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModena41125Italy
| | - Hadi Heidari
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
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14
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Kim CY, Ku MJ, Qazi R, Nam HJ, Park JW, Nam KS, Oh S, Kang I, Jang JH, Kim WY, Kim JH, Jeong JW. Soft subdermal implant capable of wireless battery charging and programmable controls for applications in optogenetics. Nat Commun 2021; 12:535. [PMID: 33483493 PMCID: PMC7822865 DOI: 10.1038/s41467-020-20803-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/17/2020] [Indexed: 11/08/2022] Open
Abstract
Optogenetics is a powerful technique that allows target-specific spatiotemporal manipulation of neuronal activity for dissection of neural circuits and therapeutic interventions. Recent advances in wireless optogenetics technologies have enabled investigation of brain circuits in more natural conditions by releasing animals from tethered optical fibers. However, current wireless implants, which are largely based on battery-powered or battery-free designs, still limit the full potential of in vivo optogenetics in freely moving animals by requiring intermittent battery replacement or a special, bulky wireless power transfer system for continuous device operation, respectively. To address these limitations, here we present a wirelessly rechargeable, fully implantable, soft optoelectronic system that can be remotely and selectively controlled using a smartphone. Combining advantageous features of both battery-powered and battery-free designs, this device system enables seamless full implantation into animals, reliable ubiquitous operation, and intervention-free wireless charging, all of which are desired for chronic in vivo optogenetics. Successful demonstration of the unique capabilities of this device in freely behaving rats forecasts its broad and practical utilities in various neuroscience research and clinical applications.
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Affiliation(s)
- Choong Yeon Kim
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Min Jeong Ku
- Department of Physiology, Graduate School of Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Raza Qazi
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
- Department of Electrical, Computer, and Energy Engineering, University of Colorado, Boulder, CO, USA
| | - Hong Jae Nam
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jong Woo Park
- Department of Physiology, Graduate School of Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kum Seok Nam
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Shane Oh
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Inho Kang
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jae-Hyung Jang
- Department of Chemical and Biomolecular Engineering, Yonsei University, Seoul, Republic of Korea
| | - Wha Young Kim
- Department of Physiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Kim
- Department of Physiology, Graduate School of Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jae-Woong Jeong
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
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15
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Holanda VM, Okun MS, Middlebrooks EH, Gungor A, Barry ME, Forder J, Foote KD. Postmortem Dissections of Common Targets for Lesion and Deep Brain Stimulation Surgeries. Neurosurgery 2020; 86:860-872. [PMID: 31504849 DOI: 10.1093/neuros/nyz318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 05/09/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The subthalamic nucleus (STN), globus pallidus internus (GPi), and pedunculopontine nucleus (PPN) are effective targets for deep brain stimulation (DBS) in many pathological conditions. Previous literature has focused on appropriate stimulation targets and their relationships with functional neuroanatomic pathways; however, comprehensive anatomic dissections illustrating these nuclei and their connections are lacking. This information will provide insight into the anatomic basis of stimulation-induced DBS benefits and side effects. OBJECTIVE To combine advanced cadaveric dissection techniques and ultrahigh field magnetic resonance imaging (MRI) to explore the anatomy of the STN, GPi, and PPN with their associated fiber pathways. METHODS A total of 10 cadaveric human brains and 2 hemispheres of a cadaveric head were examined using fiber dissection techniques. The anatomic dissections were compared with 11.1 Tesla (T) structural MRI and 4.7 T MRI fiber tractography. RESULTS The extensive connections of the STN (caudate nucleus, putamen, medial frontal cortex, substantia innominata, substantia nigra, PPN, globus pallidus externus (GPe), GPi, olfactory tubercle, hypothalamus, and mammillary body) were demonstrated. The connections of GPi to the thalamus, substantia nigra, STN, amygdala, putamen, PPN, and GPe were also illustrated. The PPN was shown to connect to the STN and GPi anteriorly, to the cerebellum inferiorly, and to the substantia nigra anteriorly and superiorly. CONCLUSION This study demonstrates connections using combined anatomic microdissections, ultrahigh field MRI, and MRI tractography. The anatomic findings are analyzed in relation to various stimulation-induced clinical effects. Precise knowledge of neuroanatomy, anatomic relationships, and fiber connections of the STN, GPi, PPN will likely enable more effective targeting and improved DBS outcomes.
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Affiliation(s)
- Vanessa M Holanda
- Fixel Institute for Neurological Diseases, Department of Neurosurgery, University of Florida, Gainesville, Florida.,Center of Neurology and Neurosurgery Associates (NeuroCENNA), BP - A Beneficência Portuguesa de São Paulo, São Paulo SP, Brazil.,Department of Neurosurgery, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Michael S Okun
- Fixel Institute for Neurological Diseases, Department of Neurology, University of Florida, Gainesville, Florida
| | - Erik H Middlebrooks
- Department of Radiology, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Abuzer Gungor
- Department of Neurosurgery, Acιbadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Margaret E Barry
- Fixel Institute for Neurological Diseases, Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - John Forder
- Department of Radiology, University of Florida, Gainesville, Florida
| | - Kelly D Foote
- Fixel Institute for Neurological Diseases, Department of Neurosurgery, University of Florida, Gainesville, Florida
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16
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Gonzalez-Escamilla G, Muthuraman M, Ciolac D, Coenen VA, Schnitzler A, Groppa S. Neuroimaging and electrophysiology meet invasive neurostimulation for causal interrogations and modulations of brain states. Neuroimage 2020; 220:117144. [DOI: 10.1016/j.neuroimage.2020.117144] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/22/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022] Open
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17
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Mueller K, Urgošík D, Ballarini T, Holiga Š, Möller HE, Růžička F, Roth J, Vymazal J, Schroeter ML, Růžička E, Jech R. Differential effects of deep brain stimulation and levodopa on brain activity in Parkinson's disease. Brain Commun 2020; 2:fcaa005. [PMID: 32954278 PMCID: PMC7425344 DOI: 10.1093/braincomms/fcaa005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/21/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Levodopa is the first-line treatment for Parkinson’s disease, although the precise mechanisms mediating its efficacy remain elusive. We aimed to elucidate treatment effects of levodopa on brain activity during the execution of fine movements and to compare them with deep brain stimulation of the subthalamic nuclei. We studied 32 patients with Parkinson’s disease using functional MRI during the execution of finger-tapping task, alternating epochs of movement and rest. The task was performed after withdrawal and administration of a single levodopa dose. A subgroup of patients (n = 18) repeated the experiment after electrode implantation with stimulator on and off. Investigating levodopa treatment, we found a significant interaction between both factors of treatment state (off, on) and experimental task (finger tapping, rest) in bilateral putamen, but not in other motor regions. Specifically, during the off state of levodopa medication, activity in the putamen at rest was higher than during tapping. This represents an aberrant activity pattern probably indicating the derangement of basal ganglia network activity due to the lack of dopaminergic input. Levodopa medication reverted this pattern, so that putaminal activity during finger tapping was higher than during rest, as previously described in healthy controls. Within-group comparison with deep brain stimulation underlines the specificity of our findings with levodopa treatment. Indeed, a significant interaction was observed between treatment approach (levodopa, deep brain stimulation) and treatment state (off, on) in bilateral putamen. Our functional MRI study compared for the first time the differential effects of levodopa treatment and deep brain stimulation on brain motor activity. We showed modulatory effects of levodopa on brain activity of the putamen during finger movement execution, which were not observed with deep brain stimulation.
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Affiliation(s)
- Karsten Mueller
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Dušan Urgošík
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Tommaso Ballarini
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Štefan Holiga
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Harald E Möller
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Filip Růžička
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jan Roth
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Josef Vymazal
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Evžen Růžička
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Robert Jech
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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18
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Boutet A, Chow CT, Narang K, Elias GJB, Neudorfer C, Germann J, Ranjan M, Loh A, Martin AJ, Kucharczyk W, Steele CJ, Hancu I, Rezai AR, Lozano AM. Improving Safety of MRI in Patients with Deep Brain Stimulation Devices. Radiology 2020; 296:250-262. [PMID: 32573388 DOI: 10.1148/radiol.2020192291] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
MRI is a valuable clinical and research tool for patients undergoing deep brain stimulation (DBS). However, risks associated with imaging DBS devices have led to stringent regulations, limiting the clinical and research utility of MRI in these patients. The main risks in patients with DBS devices undergoing MRI are heating at the electrode tips, induced currents, implantable pulse generator dysfunction, and mechanical forces. Phantom model studies indicate that electrode tip heating remains the most serious risk for modern DBS devices. The absence of adverse events in patients imaged under DBS vendor guidelines for MRI demonstrates the general safety of MRI for patients with DBS devices. Moreover, recent work indicates that-given adequate safety data-patients may be imaged outside these guidelines. At present, investigators are primarily focused on improving DBS device and MRI safety through the development of tools, including safety simulation models. Existing guidelines provide a standardized framework for performing safe MRI in patients with DBS devices. It also highlights the possibility of expanding MRI as a tool for research and clinical care in these patients going forward.
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Affiliation(s)
- Alexandre Boutet
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Clement T Chow
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Keshav Narang
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Gavin J B Elias
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Clemens Neudorfer
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Jürgen Germann
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Manish Ranjan
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Aaron Loh
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Alastair J Martin
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Walter Kucharczyk
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Christopher J Steele
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Ileana Hancu
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Ali R Rezai
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Andres M Lozano
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
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19
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Boutet A, Elias GJB, Gramer R, Neudorfer C, Germann J, Naheed A, Bennett N, Li B, Gwun D, Chow CT, Maciel R, Valencia A, Fasano A, Munhoz RP, Foltz W, Mikulis D, Hancu I, Kalia SK, Hodaie M, Kucharczyk W, Lozano AM. Safety assessment of spine MRI in deep brain stimulation patients. J Neurosurg Spine 2020; 32:973-983. [PMID: 32059193 DOI: 10.3171/2019.12.spine191241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/06/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many centers are hesitant to perform clinically indicated MRI in patients who have undergone deep brain stimulation (DBS). Highly restrictive guidelines prohibit the use of most routine clinical MRI protocols in these patients. The authors' goals were to assess the safety of spine MRI in patients with implanted DBS devices, first through phantom model testing and subsequently through validation in a DBS patient cohort. METHODS A phantom was used to assess DBS device heating during 1.5-T spine MRI. To establish a safe spine protocol, routinely used clinical sequences deemed unsafe (a rise in temperature > 2°C) were modified to decrease the rise in temperature. This safe phantom-based protocol was then used to prospectively run 67 spine MRI sequences in 9 DBS participants requiring clinical imaging. The primary outcome was acute adverse effects; secondary outcomes included long-term adverse clinical effects, acute findings on brain MRI, and device impedance stability. RESULTS The increases in temperature were highest when scanning the cervical spine and lowest when scanning the lumbar spine. A temperature rise < 2°C was achieved when 3D sequences were modified to 2D and when the number of slices was decreased by the minimum amount compared to routine spine MRI protocols (but there were still more slices than allowed by vendor guidelines). Following spine MRI, no acute or long-term adverse effects or acute findings on brain MR images were detected. Device impedances remained stable. CONCLUSIONS Patients with DBS devices may safely undergo spine MRI with a fewer number of slices compared to those used in routine clinical protocols. Safety data acquisition may allow protocols outside vendor guidelines with a maximized number of slices, reducing the need for radiologist supervision.Clinical trial registration no.: NCT03753945 (ClinicalTrials.gov).
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Affiliation(s)
- Alexandre Boutet
- 1Joint Department of Medical Imaging, University of Toronto
- 2University Health Network, Toronto
| | | | | | | | | | - Asma Naheed
- 1Joint Department of Medical Imaging, University of Toronto
| | - Nicole Bennett
- 1Joint Department of Medical Imaging, University of Toronto
| | - Bryan Li
- 2University Health Network, Toronto
| | | | | | - Ricardo Maciel
- 2University Health Network, Toronto
- 3Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto
| | | | - Alfonso Fasano
- 3Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto
- 4Krembil Brain Institute, Toronto
| | - Renato P Munhoz
- 3Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto
- 4Krembil Brain Institute, Toronto
| | - Warren Foltz
- 5Department of Radiation Oncology, STTARR Innovation Centre, University Health Network, Toronto, Ontario, Canada; and
| | - David Mikulis
- 1Joint Department of Medical Imaging, University of Toronto
- 2University Health Network, Toronto
- 4Krembil Brain Institute, Toronto
| | - Ileana Hancu
- 6National Institutes of Health, Center for Scientific Review, Bethesda, Maryland
| | | | | | - Walter Kucharczyk
- 1Joint Department of Medical Imaging, University of Toronto
- 2University Health Network, Toronto
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20
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Full activation pattern mapping by simultaneous deep brain stimulation and fMRI with graphene fiber electrodes. Nat Commun 2020; 11:1788. [PMID: 32286290 PMCID: PMC7156737 DOI: 10.1038/s41467-020-15570-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/18/2020] [Indexed: 01/01/2023] Open
Abstract
Simultaneous deep brain stimulation (DBS) and functional magnetic resonance imaging (fMRI) constitutes a powerful tool for elucidating brain functional connectivity, and exploring neuromodulatory mechanisms of DBS therapies. Previous DBS-fMRI studies could not provide full activation pattern maps due to poor MRI compatibility of the DBS electrodes, which caused obstruction of large brain areas on MRI scans. Here, we fabricate graphene fiber (GF) electrodes with high charge-injection-capacity and little-to-no MRI artifact at 9.4T. DBS-fMRI with GF electrodes at the subthalamic nucleus (STN) in Parkinsonian rats reveal robust blood-oxygenation-level-dependent responses along the basal ganglia-thalamocortical network in a frequency-dependent manner, with responses from some regions not previously detectable. This full map indicates that STN-DBS modulates both motor and non-motor pathways, possibly through orthodromic and antidromic signal propagation. With the capability for full, unbiased activation pattern mapping, DBS-fMRI using GF electrodes can provide important insights into DBS therapeutic mechanisms in various neurological disorders. Combination of fMRI and deep brain stimulation (DBS) allows for large-scale mapping of brain responses to DBS. Here the authors develop highly MRI compatible graphene fiber electrodes for full brain activation pattern mapping under DBS in Parkinsonian rats.
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21
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Boutet A, Hancu I, Saha U, Crawley A, Xu DS, Ranjan M, Hlasny E, Chen R, Foltz W, Sammartino F, Coblentz A, Kucharczyk W, Lozano AM. 3-Tesla MRI of deep brain stimulation patients: safety assessment of coils and pulse sequences. J Neurosurg 2020; 132:586-594. [PMID: 30797197 DOI: 10.3171/2018.11.jns181338] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Physicians are more frequently encountering patients who are treated with deep brain stimulation (DBS), yet many MRI centers do not routinely perform MRI in this population. This warrants a safety assessment to improve DBS patients' accessibility to MRI, thereby improving their care while simultaneously providing a new tool for neuromodulation research. METHODS A phantom simulating a patient with a DBS neuromodulation device (DBS lead model 3387 and IPG Activa PC model 37601) was constructed and used. Temperature changes at the most ventral DBS electrode contacts, implantable pulse generator (IPG) voltages, specific absorption rate (SAR), and B1+rms were recorded during 3-T MRI scanning. Safety data were acquired with a transmit body multi-array receive and quadrature transmit-receive head coil during various pulse sequences, using numerous DBS configurations from "the worst" to "the most common."In addition, 3-T MRI scanning (T1 and fMRI) was performed on 41 patients with fully internalized and active DBS using a quadrature transmit-receive head coil. MR images, neurological examination findings, and stability of the IPG impedances were assessed. RESULTS In the phantom study, temperature rises at the DBS electrodes were less than 2°C for both coils during 3D SPGR, EPI, DTI, and SWI. Sequences with intense radiofrequency pulses such as T2-weighted sequences may cause higher heating (due to their higher SAR). The IPG did not power off and kept a constant firing rate, and its average voltage output was unchanged. The 41 DBS patients underwent 3-T MRI with no adverse event. CONCLUSIONS Under the experimental conditions used in this study, 3-T MRI scanning of DBS patients with selected pulse sequences appears to be safe. Generally, T2-weighted sequences (using routine protocols) should be avoided in DBS patients. Complementary 3-T MRI phantom safety data suggest that imaging conditions that are less restrictive than those used in the patients in this study, such as using transmit body multi-array receive coils, may also be safe. Given the interplay between the implanted DBS neuromodulation device and the MRI system, these findings are specific to the experimental conditions in this study.
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Affiliation(s)
- Alexandre Boutet
- 1Joint Department of Medical Imaging, and
- 2University Health Network; and
| | - Ileana Hancu
- 3GE Global Research Center, Niskayuna, New York; and
| | - Utpal Saha
- 4Krembil Research Institute, Toronto, Ontario, Canada
| | - Adrian Crawley
- 1Joint Department of Medical Imaging, and
- 2University Health Network; and
| | | | | | | | - Robert Chen
- 2University Health Network; and
- 5Division of Neurology, Department of Medicine, University of Toronto
| | - Warren Foltz
- 6STTARR Innovation Centre, Department of Radiation Oncology
| | | | - Ailish Coblentz
- 1Joint Department of Medical Imaging, and
- 2University Health Network; and
| | - Walter Kucharczyk
- 1Joint Department of Medical Imaging, and
- 2University Health Network; and
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22
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Muller J, Alizadeh M, Li L, Thalheimer S, Matias C, Tantawi M, Miao J, Silverman M, Zhang V, Yun G, Romo V, Mohamed FB, Wu C. Feasibility of diffusion and probabilistic white matter analysis in patients implanted with a deep brain stimulator. Neuroimage Clin 2019; 25:102135. [PMID: 31901789 PMCID: PMC6948366 DOI: 10.1016/j.nicl.2019.102135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/27/2019] [Accepted: 12/13/2019] [Indexed: 01/03/2023]
Abstract
Deep brain stimulation (DBS) for Parkinson's disease (PD) is an established advanced therapy that produces therapeutic effects through high frequency stimulation. Although this therapeutic option leads to improved clinical outcomes, the mechanisms of the underlying efficacy of this treatment are not well understood. Therefore, investigation of DBS and its postoperative effects on brain architecture is of great interest. Diffusion weighted imaging (DWI) is an advanced imaging technique, which has the ability to estimate the structure of white matter fibers; however, clinical application of DWI after DBS implantation is challenging due to the strong susceptibility artifacts caused by implanted devices. This study aims to evaluate the feasibility of generating meaningful white matter reconstructions after DBS implantation; and to subsequently quantify the degree to which these tracts are affected by post-operative device-related artifacts. DWI was safely performed before and after implanting electrodes for DBS in 9 PD patients. Differences within each subject between pre- and post-implantation FA, MD, and RD values for 123 regions of interest (ROIs) were calculated. While differences were noted globally, they were larger in regions directly affected by the artifact. White matter tracts were generated from each ROI with probabilistic tractography, revealing significant differences in the reconstruction of several white matter structures after DBS. Tracts pertinent to PD, such as regions of the substantia nigra and nigrostriatal tracts, were largely unaffected. The aim of this study was to demonstrate the feasibility and clinical applicability of acquiring and processing DWI post-operatively in PD patients after DBS implantation. The presence of global differences provides an impetus for acquiring DWI shortly after implantation to establish a new baseline against which longitudinal changes in brain connectivity in DBS patients can be compared. Understanding that post-operative fiber tracking in patients is feasible on a clinically-relevant scale has significant implications for increasing our current understanding of the pathophysiology of movement disorders, and may provide insights into better defining the pathophysiology and therapeutic effects of DBS.
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Affiliation(s)
- J Muller
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States.
| | - M Alizadeh
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - L Li
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - S Thalheimer
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - C Matias
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - M Tantawi
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - J Miao
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - M Silverman
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - V Zhang
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - G Yun
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - V Romo
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - F B Mohamed
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - C Wu
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States
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23
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Golestanirad L, Kazemivalipour E, Lampman D, Habara H, Atalar E, Rosenow J, Pilitsis J, Kirsch J. RF heating of deep brain stimulation implants in open-bore vertical MRI systems: A simulation study with realistic device configurations. Magn Reson Med 2019; 83:2284-2292. [PMID: 31677308 DOI: 10.1002/mrm.28049] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Patients with deep brain stimulation (DBS) implants benefit highly from MRI, however, access to MRI is restricted for these patients because of safety hazards associated with RF heating of the implant. To date, all MRI studies on RF heating of medical implants have been performed in horizontal closed-bore systems. Vertical MRI scanners have a fundamentally different distribution of electric and magnetic fields and are now available at 1.2T, capable of high-resolution structural and functional MRI. This work presents the first simulation study of RF heating of DBS implants in high-field vertical scanners. METHODS We performed finite element electromagnetic simulations to calculate specific absorption rate (SAR) at tips of DBS leads during MRI in a commercially available 1.2T vertical coil compared to a 1.5T horizontal scanner. Both isolated leads and fully implanted systems were included. RESULTS We found 10- to 30-fold reduction in SAR implication at tips of isolated DBS leads, and up to 19-fold SAR reduction at tips of leads in fully implanted systems in vertical coils compared to horizontal birdcage coils. CONCLUSIONS If confirmed in larger patient cohorts and verified experimentally, this result can open the door to plethora of structural and functional MRI applications to guide, interpret, and advance DBS therapy.
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Affiliation(s)
- Laleh Golestanirad
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois
| | - Ehsan Kazemivalipour
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Electrical and Electronics Engineering, Bilkent University, Ankara, Turkey.,National Magnetic Resonance Research Center (UMRAM), Bilkent University, Ankara, Turkey
| | | | - Hideta Habara
- Hitachi, Ltd. Healthcare Business Unit, Tokyo, Japan
| | - Ergin Atalar
- Department of Electrical and Electronics Engineering, Bilkent University, Ankara, Turkey.,National Magnetic Resonance Research Center (UMRAM), Bilkent University, Ankara, Turkey
| | - Joshua Rosenow
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Julie Pilitsis
- Department of Neurosurgery, Albany Medical Center, Albany, New York
| | - John Kirsch
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts
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24
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Martin AJ. MRI in Patients with Deep Brain Stimulation Electrodes: Balancing Risks and Benefits. Radiology 2019; 293:184-185. [PMID: 31389745 DOI: 10.1148/radiol.2019191558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alastair J Martin
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Suite L-310, San Francisco, CA 94143
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25
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Golestanirad L, Kazemivalipour E, Keil B, Downs S, Kirsch J, Elahi B, Pilitsis J, Wald LL. Reconfigurable MRI coil technology can substantially reduce RF heating of deep brain stimulation implants: First in-vitro study of RF heating reduction in bilateral DBS leads at 1.5 T. PLoS One 2019; 14:e0220043. [PMID: 31390346 PMCID: PMC6685612 DOI: 10.1371/journal.pone.0220043] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 07/08/2019] [Indexed: 12/12/2022] Open
Abstract
Patients with deep brain stimulation (DBS) implants can significantly benefit from magnetic resonance imaging (MRI), however access to MRI is restricted in these patients because of safety concerns due to RF heating of the leads. Recently we introduced a patient-adjustable reconfigurable transmit coil for low-SAR imaging of DBS at 1.5T. A previous simulation study demonstrated a substantial reduction in the local SAR around single DBS leads in 9 unilateral lead models. This work reports the first experimental results of temperature measurement at the tips of bilateral DBS leads with realistic trajectories extracted from postoperative CT images of 10 patients (20 leads in total). A total of 200 measurements were performed to record temperature rise at the tips of the leads during 2 minutes of scanning with the coil rotated to cover all accessible rotation angles. In all patients, we were able to find an optimum coil rotation angle and reduced the heating of both left and right leads to a level below the heating produced by the body coil. An average heat reduction of 65% was achieved for bilateral leads. When considering each lead alone, an average heat reduction of 80% was achieved. Our results suggest that reconfigurable coil technology introduces a promising approach for imaging of patients with DBS implants.
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Affiliation(s)
- Laleh Golestanirad
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States of America
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Ehsan Kazemivalipour
- Department of Electrical and Electronics Engineering, Bilkent University, Ankara, Turkey
| | - Boris Keil
- Department of Life Science Engineering, Institute of Medical Physics and Radiation Protection, Giessen, Germany
| | - Sean Downs
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America
| | - John Kirsch
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America
| | - Behzad Elahi
- Department of Neurology, Bryan Health, Lincoln, NE, United States of America
| | - Julie Pilitsis
- Department of Neurosurgery, Albany Medical Center, Albany, NY, United States of America
| | - Lawrence L. Wald
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America
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26
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Early detection of cerebral ischemic events on intraoperative magnetic resonance imaging during surgical procedures for deep brain stimulation. Acta Neurochir (Wien) 2019; 161:1545-1558. [PMID: 31053908 DOI: 10.1007/s00701-019-03929-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although intracerebral hemorrhage is the most feared complication of deep brain stimulation (DBS) surgery, cerebral ischemic events in association with DBS surgery have only rarely been described. We therefore evaluated the role of intraoperative MRI (iMRI) for early identification of cerebral ischemic events during DBS procedures and determined how ischemic infarctions affect patients over acute and long-term periods. METHODS Between January 2010 and December 2017, 1160 DBS electrodes were implanted in 595 patients at Chinese People's Liberation Army General Hospital, with the help of iMRI. The iMRI was performed in all patients after implantation, to define the accuracy of lead placement and detect complications. A CT scan was performed on postoperative days 1 to 7. RESULTS The iMRI showed that cerebral ischemic changes happened in nine (1.51% of patients, 0.78% of leads) patients. Only two (0.34%) of nine patients had an ischemic infarction in the basal ganglia, while seven (1.18%) had cortical ischemia. Six (67%) of the nine patients had long-term complications, two with mild hemiparesis, two with seizures, one with language dysfunction, and one with memory loss. Of those with a cortical ischemic infarction, only three (42.86%) of seven patients had no long-term complications. Long-term follow-up imaging showed that not all the patients recovered normal morphological structure in the area of ischemic foci. The factors of sex, age, target, and anesthesia were not related to ischemic events. In six (66.7%) cases, the entry point on the cortex or the path was not ideal. CONCLUSIONS Intraoperative ischemic events are not uncommon in DBS surgery. Ischemia can cause serious permanent complications, and regions subject to severe ischemia cannot be restored; it is therefore necessary to pay careful attention to any signs of ischemia. iMRI objectively provides the basis for early diagnosis of intraoperative ischemic infarction, providing guidance for follow-up treatment. The deviation in the entry point on the cortex or in the path resulted in vascular injury; it may be the key cause of ischemic events during DBS procedures.
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27
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Prezelj N, Trošt M, Georgiev D, Flisar D. Lightning may pose a danger to patients receiving deep brain stimulation: case report. J Neurosurg 2019; 130:763-765. [PMID: 29712499 DOI: 10.3171/2017.12.jns172258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/11/2017] [Indexed: 11/06/2022]
Abstract
Deep brain stimulation (DBS) is an established treatment option for advanced stages of Parkinson's disease and other movement disorders. It is known that DBS is susceptible to strong electromagnetic fields (EMFs) that can be generated by various electrical devices at work, home, and in medical environments. EMFs can interfere with the proper functioning of implantable pulse generators (IPGs). Very strong EMFs can generate induction currents in implanted electrodes and even damage the brain. Manufacturers of DBS devices have issued a list of warnings on how to avoid this danger.Strong EMFs can result from natural forces as well. The authors present the case of a 66-year-old woman who was being treated with a rechargeable DBS system for neck dystonia when her apartment was struck by lightning. Domestic electronic devices that were operating during the event were burned and destroyed. The woman's IPG switched off but remained undamaged, and she suffered no neurological consequences.
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Affiliation(s)
- Neža Prezelj
- 1Department of Neurology, University Medical Centre Ljubljana; and
| | - Maja Trošt
- 1Department of Neurology, University Medical Centre Ljubljana; and
- 2Faculty of Medicine, University of Ljubljana, Slovenia
| | - Dejan Georgiev
- 1Department of Neurology, University Medical Centre Ljubljana; and
| | - Dušan Flisar
- 1Department of Neurology, University Medical Centre Ljubljana; and
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28
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Borellini L, Ardolino G, Carrabba G, Locatelli M, Rampini P, Sbaraini S, Scola E, Avignone S, Triulzi F, Barbieri S, Cogiamanian F. Peri-lead edema after deep brain stimulation surgery for Parkinson's disease: a prospective magnetic resonance imaging study. Eur J Neurol 2018; 26:533-539. [PMID: 30358915 DOI: 10.1111/ene.13852] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/16/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to define the prevalence and characteristics of peri-electrode edema in a prospective cohort of patients undergoing deep brain stimulation (DBS) surgery and to correlate it with clinical findings. METHODS We performed brain magnetic resonance imaging (MRI) between 7 and 20 days after surgery in 19 consecutive patients undergoing DBS surgery for Parkinson's disease. The T2-weighted hyperintensity surrounding DBS leads was characterized and quantified. Any evidence of bleeding around the leads was also evaluated. Clinical and follow-up data were recorded. In a subgroup of patients, a follow-up MRI was performed 3-6 weeks after surgery. We also retrospectively reviewed the post-operative computed tomography scans of patients who underwent DBS at our center since 2013. RESULTS Magnetic resonance imaging showed a peri-lead edematous reaction in all (100%) patients, which was unilateral in three patients (15.8%). In six patients (31.6%), we detected minor peri-lead hemorrhage. Edema completely resolved in eight out of 11 patients with a follow-up MRI and was markedly reduced in the others. Most patients were asymptomatic but six (31.6%) manifested various degrees of confusional state without motor symptoms. We found no significant correlation between edema volume, distribution and any clinical feature, including new post-operative neurological symptoms. The retrospective computed tomography analysis showed that peri-electrode hypodensity consistent with edema is absent at early post-operative imaging but is common at scans performed >3 days after surgery. CONCLUSIONS Peri-electrode edema is a common, transient reaction to DBS lead placement and a convincing relation between edema and post-operative clinical status is lacking.
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Affiliation(s)
- L Borellini
- U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - G Ardolino
- U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - G Carrabba
- U.O. Neurochirurgia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - M Locatelli
- U.O. Neurochirurgia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - P Rampini
- U.O. Neurochirurgia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - S Sbaraini
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - E Scola
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - S Avignone
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - F Triulzi
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Dipartimento di Fisiopatologia e dei Trapianti, Università degli Studi di Milano, Milano, Italy
| | - S Barbieri
- U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - F Cogiamanian
- U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Muthuraman M, Koirala N, Ciolac D, Pintea B, Glaser M, Groppa S, Tamás G, Groppa S. Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease. Front Neurol 2018; 9:711. [PMID: 30210436 PMCID: PMC6119713 DOI: 10.3389/fneur.2018.00711] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/06/2018] [Indexed: 12/15/2022] Open
Abstract
L-DOPA is still the most effective pharmacological therapy for the treatment of motor symptoms in Parkinson's disease (PD) almost four decades after it was first used. Deep brain stimulation (DBS) is a safe and highly effective treatment option in patients with PD. Even though a clear understanding of the mechanisms of both treatment methods is yet to be obtained, the combination of both treatments is the most effective standard evidenced-based therapy to date. Recent studies have demonstrated that DBS is a therapy option even in the early course of the disease, when first complications arise despite a rigorous adjustment of the pharmacological treatment. The unique feature of this therapeutic approach is the ability to preferentially modulate specific brain networks through the choice of stimulation site. The clinical effects have been unequivocally confirmed in recent studies; however, the impact of DBS and the supplementary effect of L-DOPA on the neuronal network are not yet fully understood. In this review, we present emerging data on the presumable mechanisms of DBS in patients with PD and discuss the pathophysiological similarities and differences in the effects of DBS in comparison to dopaminergic medication. Targeted, selective modulation of brain networks by DBS and pharmacodynamic effects of L-DOPA therapy on the central nervous system are presented. Moreover, we outline the perioperative algorithms for PD patients before and directly after the implantation of DBS electrodes and strategies for the reduction of side effects and optimization of motor and non-motor symptoms.
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Affiliation(s)
- Muthuraman Muthuraman
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Nabin Koirala
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Dumitru Ciolac
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Bogdan Pintea
- Department of Neurosurgery, University Hospital of Bonn, Bonn, Germany
| | - Martin Glaser
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stanislav Groppa
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Gertrúd Tamás
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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30
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Erhardt JB, Fuhrer E, Gruschke OG, Leupold J, Wapler MC, Hennig J, Stieglitz T, Korvink JG. Should patients with brain implants undergo MRI? J Neural Eng 2018. [DOI: 10.1088/1741-2552/aab4e4] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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31
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Bhusal B, Bhattacharyya P, Baig T, Jones S, Martens M. Measurements and simulation of RF heating of implanted stereo-electroencephalography electrodes during MR scans. Magn Reson Med 2018; 80:1676-1685. [DOI: 10.1002/mrm.27144] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/26/2018] [Accepted: 01/31/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Bhumi Bhusal
- Department of Physics; Case Western Reserve University; Cleveland Ohio USA
| | - Pallab Bhattacharyya
- Imaging Institute, Cleveland Clinic; Cleveland Ohio USA
- Radiology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University; Cleveland Ohio USA
| | - Tanvir Baig
- Department of Physics; Case Western Reserve University; Cleveland Ohio USA
| | - Stephen Jones
- Imaging Institute, Cleveland Clinic; Cleveland Ohio USA
- Epilepsy Center, Cleveland Clinic; Cleveland Ohio USA
| | - Michael Martens
- Department of Physics; Case Western Reserve University; Cleveland Ohio USA
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34
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Xia J, He P, Cai X, Zhang D, Xie N. Magnetic resonance and computed tomography image fusion technology in patients with Parkinson's disease after deep brain stimulation. J Neurol Sci 2017; 381:250-255. [PMID: 28991693 DOI: 10.1016/j.jns.2017.08.3267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 08/31/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
Electrode position after deep brain stimulation (DBS) for Parkinson's disease (PD) needs to be confirmed, but there are concerns about the risk of postoperative magnetic resonance imaging (MRI) after DBS. These issues could be avoided by fusion images obtained from preoperative MRI and postoperative computed tomography (CT). This study aimed to investigate image fusion technology for displaying the position of the electrodes compared with postoperative MRI. This was a retrospective study of 32 patients with PD treated with bilateral subthalamic nucleus (STN) DBS between April 2015 and March 2016. The postoperative (same day) CT and preoperative MRI were fused using the Elekta Leksell 10.1 planning workstation (Elekta Instruments, Stockholm, Sweden). The position of the electrodes was compared between the fusion images and postoperative 1-2-week MRI. The position of the electrodes was highly correlated between the fusion and postoperative MRI (all r between 0.865 and 0.996; all P<0.001). The differences of the left electrode position in the lateral and vertical planes was significantly different between the two methods (0.30 and 0.24mm, respectively, both P<0.05), but there were no significant differences for the other electrode and planes (all P>0.05). The position of the electrodes was highly correlated between the fusion and postoperative MRI. The CT-MRI fusion images could be used to avoid the potential risks of MRI after DBS in patients with PD.
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Affiliation(s)
- Jun Xia
- Department of Radiology, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China
| | - Pin He
- Department of Radiology, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China
| | - Xiaodong Cai
- Department of Neurosurgery, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China
| | - Doudou Zhang
- Department of Neurosurgery, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China
| | - Ni Xie
- Central Laboratory, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China.
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36
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Gilmore G, Lee DH, Parrent A, Jog M. The current state of postoperative imaging in the presence of deep brain stimulation electrodes. Mov Disord 2017; 32:833-838. [DOI: 10.1002/mds.27028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/01/2017] [Accepted: 03/31/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Greydon Gilmore
- Department of Biomedical Engineering; Western University; London Canada
- Department of Clinical Neurological Sciences; University Hospital; London Canada
| | - Donald H. Lee
- Department of Medical Imaging; University Hospital; London Canada
| | - Andrew Parrent
- Department of Clinical Neurological Sciences; University Hospital; London Canada
- Department of Neurosurgery; University Hospital; London Canada
| | - Mandar Jog
- Department of Biomedical Engineering; Western University; London Canada
- Department of Clinical Neurological Sciences; University Hospital; London Canada
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Thornton JS. Technical challenges and safety of magnetic resonance imaging with in situ neuromodulation from spine to brain. Eur J Paediatr Neurol 2017; 21:232-241. [PMID: 27430172 DOI: 10.1016/j.ejpn.2016.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE This review summarises the need for MRI with in situ neuromodulation, the key safety challenges and how they may be mitigated, and surveys the current status of MRI safety for the main categories of neuro-stimulation device, including deep brain stimulation, vagus nerve stimulation, sacral neuromodulation, spinal cord stimulation systems, and cochlear implants. REVIEW SUMMARY When neuro-stimulator systems are introduced into the MRI environment a number of hazards arise with potential for patient harm, in particular the risk of thermal injury due to MRI-induced heating. For many devices however, safe MRI conditions can be determined, and MRI safely performed, albeit with possible compromise in anatomical coverage, image quality or extended acquisition time. CONCLUSIONS The increasing availability of devices conditional for 3 T MRI, whole-body transmit imaging, and imaging in the on-stimulation condition, will be of significant benefit to the growing population of patients benefitting from neuromodulation therapy, and open up new opportunities for functional imaging research.
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Affiliation(s)
- John S Thornton
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, Queen Square, London, UK; Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, UK.
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38
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Golestanirad L, Iacono MI, Keil B, Angelone LM, Bonmassar G, Fox MD, Herrington T, Adalsteinsson E, LaPierre C, Mareyam A, Wald LL. Construction and modeling of a reconfigurable MRI coil for lowering SAR in patients with deep brain stimulation implants. Neuroimage 2016; 147:577-588. [PMID: 28011252 DOI: 10.1016/j.neuroimage.2016.12.056] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 11/13/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022] Open
Abstract
Post-operative MRI of patients with deep brain simulation (DBS) implants is useful to assess complications and diagnose comorbidities, however more than one third of medical centers do not perform MRIs on this patient population due to stringent safety restrictions and liability risks. A new system of reconfigurable magnetic resonance imaging head coil composed of a rotatable linearly-polarized birdcage transmitter and a close-fitting 32-channel receive array is presented for low-SAR imaging of patients with DBS implants. The novel system works by generating a region with low electric field magnitude and steering it to coincide with the DBS lead trajectory. We demonstrate that the new coil system substantially reduces the SAR amplification around DBS electrodes compared to commercially available circularly polarized coils in a cohort of 9 patient-derived realistic DBS lead trajectories. We also show that the optimal coil configuration can be reliably identified from the image artifact on B1+ field maps. Our preliminary results suggest that such a system may provide a viable solution for high-resolution imaging of DBS patients in the future. More data is needed to quantify safety limits and recommend imaging protocols before the novel coil system can be used on patients with DBS implants.
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Affiliation(s)
- Laleh Golestanirad
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Maria Ida Iacono
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - Boris Keil
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Institute of Medical Physics and Radiation Protection, THM, Life Science Engineering, Giessen, Germany
| | - Leonardo M Angelone
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - Giorgio Bonmassar
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Michael D Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Todd Herrington
- Partners Neurology, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elfar Adalsteinsson
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Electrical Engineering and Computer Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, USA
| | - Cristen LaPierre
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Azma Mareyam
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Lawrence L Wald
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Golestanirad L, Angelone LM, Iacono MI, Katnani H, Wald LL, Bonmassar G. Local SAR near deep brain stimulation (DBS) electrodes at 64 and 127 MHz: A simulation study of the effect of extracranial loops. Magn Reson Med 2016; 78:1558-1565. [PMID: 27797157 DOI: 10.1002/mrm.26535] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/12/2016] [Accepted: 10/10/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE MRI may cause brain tissue around deep brain stimulation (DBS) electrodes to become excessively hot, causing lesions. The presence of extracranial loops in the DBS lead trajectory has been shown to affect the specific absorption rate (SAR) of the radiofrequency energy at the electrode tip, but experimental studies have reported controversial results. The goal of this study was to perform a systematic numerical study to provide a better understanding of the effects of extracranial loops in DBS leads on the local SAR during MRI at 64 and 127 MHz. METHODS A total of 160 numerical simulations were performed on patient-derived data, in which relevant factors including lead length and trajectory, loop location and topology, and frequency of MRI radiofrequency (RF) transmitter were assessed. RESULTS Overall, the presence of extracranial loops reduced the local SAR in the tissue around the DBS tip compared with straight trajectories with the same length. SAR reduction was significantly larger at 127 MHz compared with 64 MHz. SAR reduction was significantly more sensitive to variable loop parameters (eg, topology and location) at 127 MHz compared with 64 MHz. CONCLUSION Lead management strategies could exist that significantly reduce the risks of 3 Tesla (T) MRI for DBS patients. Magn Reson Med 78:1558-1565, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Laleh Golestanirad
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Leonardo M Angelone
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Maria Ida Iacono
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Husam Katnani
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lawrence L Wald
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Giorgio Bonmassar
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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40
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Albaugh DL, Salzwedel A, Van Den Berge N, Gao W, Stuber GD, Shih YYI. Functional Magnetic Resonance Imaging of Electrical and Optogenetic Deep Brain Stimulation at the Rat Nucleus Accumbens. Sci Rep 2016; 6:31613. [PMID: 27601003 PMCID: PMC5013271 DOI: 10.1038/srep31613] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/25/2016] [Indexed: 01/16/2023] Open
Abstract
Deep brain stimulation of the nucleus accumbens (NAc-DBS) is an emerging therapy for diverse, refractory neuropsychiatric diseases. Although DBS therapy is broadly hypothesized to work through large-scale neural modulation, little is known regarding the neural circuits and networks affected by NAc-DBS. Using a healthy, sedated rat model of NAc-DBS, we employed both evoked- and functional connectivity (fc) MRI to examine the functional circuit and network changes achieved by electrical NAc stimulation. Optogenetic-fMRI experiments were also undertaken to evaluate the circuit modulation profile achieved by selective stimulation of NAc neurons. NAc-DBS directly modulated neural activity within prefrontal cortex and a large number of subcortical limbic areas (e.g., amygdala, lateral hypothalamus), and influenced functional connectivity among sensorimotor, executive, and limbic networks. The pattern and extent of circuit modulation measured by evoked-fMRI was relatively insensitive to DBS frequency. Optogenetic stimulation of NAc cell bodies induced a positive fMRI signal in the NAc, but no other detectable downstream responses, indicating that therapeutic NAc-DBS might exert its effect through antidromic stimulation. Our study provides a comprehensive mapping of circuit and network-level neuromodulation by NAc-DBS, which should facilitate our developing understanding of its therapeutic mechanisms of action.
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Affiliation(s)
- Daniel L. Albaugh
- Department of Neurology, University of North Carolina, Chapel Hill, NC, 27599, USA
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, 27599, USA
- Curriculum in Neurobiology, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Andrew Salzwedel
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, 27599, USA
- Department of Radiology, University of North Carolina, Chapel Hill, NC, 27599, USA
- Biomedical Imaging Research Institute, Department of Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Nathalie Van Den Berge
- Department of Neurology, University of North Carolina, Chapel Hill, NC, 27599, USA
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, 27599, USA
- Medical Image and Signal Processing Group, Ghent University, Ghent, 9000, Belgium
| | - Wei Gao
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, 27599, USA
- Department of Radiology, University of North Carolina, Chapel Hill, NC, 27599, USA
- Biomedical Imaging Research Institute, Department of Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Garret D. Stuber
- Curriculum in Neurobiology, University of North Carolina, Chapel Hill, NC, 27599, USA
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Yen-Yu Ian Shih
- Department of Neurology, University of North Carolina, Chapel Hill, NC, 27599, USA
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, 27599, USA
- Curriculum in Neurobiology, University of North Carolina, Chapel Hill, NC, 27599, USA
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC, 27599, USA
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Saleh C, Dooms G, Berthold C, Hertel F. Post-operative imaging in deep brain stimulation: A controversial issue. Neuroradiol J 2016; 29:244-9. [PMID: 27029393 PMCID: PMC4978322 DOI: 10.1177/1971400916639960] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In deep brain stimulation (DBS), post-operative imaging has been used on the one hand to assess complications, such as haemorrhage; and on the other hand, to detect misplaced contacts. The post-operative determination of the accurate location of the final electrode plays a critical role in evaluating the precise area of effective stimulation and for predicting the potential clinical outcome; however, safety remains a priority in postoperative DBS imaging. A plethora of diverse post-operative imaging methods have been applied at different centres. There is neither a consensus on the most efficient post-operative imaging methodology, nor is there any standardisation for the automatic or manual analysis of the images within the different imaging modalities. In this article, we give an overview of currently applied post-operative imaging modalities and discuss the current challenges in post-operative imaging in DBS.
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Affiliation(s)
- Christian Saleh
- Department of Neurology, Centre Hospitalier de Luxembourg, Luxembourg
| | - Georges Dooms
- Department of Neuroradiology, Centre Hospitalier de Luxembourg, Luxembourg
| | | | - Frank Hertel
- Department of Neurosurgery, Centre Hospitalier de Luxembourg, Luxembourg
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42
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Ughratdar I, Samuel M, Ashkan K. Technological Advances in Deep Brain Stimulation. JOURNAL OF PARKINSONS DISEASE 2016; 5:483-96. [PMID: 26406128 DOI: 10.3233/jpd-150579] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Functional and stereotactic neurosurgery has always been regarded as a subspecialty based on and driven by technological advances. However until recently, the fundamentals of deep brain stimulation (DBS) hardware and software design had largely remained stagnant since its inception almost three decades ago. Recent improved understanding of disease processes in movement disorders as well clinician and patient demands has resulted in new avenues of development for DBS technology. This review describes new advances both related to hardware and software for neuromodulation. New electrode designs with segmented contacts now enable sophisticated shaping and sculpting of the field of stimulation, potentially allowing multi-target stimulation and avoidance of side effects. To avoid lengthy programming sessions utilising multiple lead contacts, new user-friendly software allows for computational modelling and individualised directed programming. Therapy delivery is being improved with the next generation of smaller profile, longer-lasting, re-chargeable implantable pulse generators (IPGs). These include IPGs capable of delivering constant current stimulation or personalised closed-loop adaptive stimulation. Post-implantation Magnetic Resonance Imaging (MRI) has long been an issue which has been partially overcome with 'MRI conditional devices' and has enabled verification of DBS lead location. Surgical technique is considering a shift from frame-based to frameless stereotaxy or greater role for robot assisted implantation. The challenge for these contemporary techniques however, will be in demonstrating equivalent safety and accuracy to conventional methods. We also discuss potential future direction utilising wireless technology allowing for miniaturisation of hardware.
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Franceschi AM, Wiggins GC, Mogilner AY, Shepherd T, Chung S, Lui YW. Optimized, Minimal Specific Absorption Rate MRI for High-Resolution Imaging in Patients with Implanted Deep Brain Stimulation Electrodes. AJNR Am J Neuroradiol 2016; 37:1996-2000. [PMID: 27418467 DOI: 10.3174/ajnr.a4865] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 05/04/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Obtaining high-resolution brain MR imaging in patients with a previously implanted deep brain stimulator has been challenging and avoided by many centers due to safety concerns relating to implantable devices. We present our experience with a practical clinical protocol at 1.5T by using 2 magnet systems capable of achieving presurgical quality imaging in patients undergoing bilateral, staged deep brain stimulator insertion. MATERIALS AND METHODS Protocol optimization was performed to minimize the specific absorption rate while providing image quality necessary for adequate surgical planning of the second electrode placement. We reviewed MR imaging studies performed with a minimal specific absorption rate protocol in patients with a deep brain stimulator in place at our institution between February 1, 2012, and August 1, 2015. Images were reviewed by a neuroradiologist and a functional neurosurgeon. Image quality was qualitatively graded, and the presence of artifacts was noted. RESULTS Twenty-nine patients (22 with Parkinson disease, 6 with dystonia, 1 with essential tremor) were imaged with at least 1 neuromodulation implant in situ. All patients were imaged under general anesthesia. There were 25 subthalamic and 4 globus pallidus implants. Nineteen patients were preoperative for the second stage of bilateral deep brain stimulator placement; 10 patients had bilateral electrodes in situ and were being imaged for other neurologic indications, including lead positioning. No adverse events occurred during or after imaging. Mild device-related local susceptibility artifacts were present in all studies, but they were not judged to affect overall image quality. Minimal aliasing artifacts were seen in 7, and moderate motion, in 4 cases on T1WI only. All preoperative studies were adequate for guidance of a second deep brain stimulator placement. CONCLUSIONS An optimized MR imaging protocol that minimizes the specific absorption rate can be used to safely obtain high-quality images in patients with previously implanted deep brain stimulators, and these images are adequate for surgical guidance.
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Affiliation(s)
- A M Franceschi
- From the Departments of Radiology (A.M.F., G.C.W., T.S., S.C., Y.W.L.)
| | - G C Wiggins
- From the Departments of Radiology (A.M.F., G.C.W., T.S., S.C., Y.W.L.)
| | - A Y Mogilner
- Neurosurgery (A.Y.M.), New York University School of Medicine, New York, New York
| | - T Shepherd
- From the Departments of Radiology (A.M.F., G.C.W., T.S., S.C., Y.W.L.)
| | - S Chung
- From the Departments of Radiology (A.M.F., G.C.W., T.S., S.C., Y.W.L.)
| | - Y W Lui
- From the Departments of Radiology (A.M.F., G.C.W., T.S., S.C., Y.W.L.)
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Cui Z, Pan L, Song H, Xu X, Xu B, Yu X, Ling Z. Intraoperative MRI for optimizing electrode placement for deep brain stimulation of the subthalamic nucleus in Parkinson disease. J Neurosurg 2016; 124:62-9. [DOI: 10.3171/2015.1.jns141534] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The degree of clinical improvement achieved by deep brain stimulation (DBS) is largely dependent on the accuracy of lead placement. This study reports on the evaluation of intraoperative MRI (iMRI) for adjusting deviated electrodes to the accurate anatomical position during DBS surgery and acute intracranial changes.
METHODS
Two hundred and six DBS electrodes were implanted in the subthalamic nucleus (STN) in 110 patients with Parkinson disease. All patients underwent iMRI after implantation to define the accuracy of lead placement. Fifty-six DBS electrode positions in 35 patients deviated from the center of the STN, according to the result of the initial postplacement iMRI scans. Thus, we adjusted the electrode positions for placement in the center of the STN and verified this by means of second or third iMRI scans. Recording was performed in adjusted parameters in the x-, y-, and z-axes.
RESULTS
Fifty-six (27%) of 206 DBS electrodes were adjusted as guided by iMRI. Electrode position was adjusted on the basis of iMRI 62 times. The sum of target coordinate adjustment was −0.5 mm in the x-axis, −4 mm in the y-axis, and 15.5 mm in the z-axis; the total of distance adjustment was 74.5 mm in the x-axis, 88 mm in the y-axis, and 42.5 mm in the z-axis. After adjustment with the help of iMRI, all electrodes were located in the center of the STN. Intraoperative MRI revealed 2 intraparenchymal hemorrhages in 2 patients, brain shift in all patients, and leads penetrating the lateral ventricle in 3 patients.
CONCLUSIONS
The iMRI technique can guide surgeons as they adjust deviated electrodes to improve the accuracy of implanting the electrodes into the correct anatomical position. The iMRI technique can also immediately demonstrate acute changes such as hemorrhage and brain shift during DBS surgery.
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Affiliation(s)
- Zhiqiang Cui
- 1Department of Neurosurgery, PLA General Hospital, PLA Postgraduate Medical School, Beijing; and
| | - Longsheng Pan
- 1Department of Neurosurgery, PLA General Hospital, PLA Postgraduate Medical School, Beijing; and
| | - Huifang Song
- 2Department of Neurology, Hebei Province Luan County People’s Hospital, Luan County, Hebei Province, China
| | - Xin Xu
- 1Department of Neurosurgery, PLA General Hospital, PLA Postgraduate Medical School, Beijing; and
| | - Bainan Xu
- 1Department of Neurosurgery, PLA General Hospital, PLA Postgraduate Medical School, Beijing; and
| | - Xinguang Yu
- 1Department of Neurosurgery, PLA General Hospital, PLA Postgraduate Medical School, Beijing; and
| | - Zhipei Ling
- 1Department of Neurosurgery, PLA General Hospital, PLA Postgraduate Medical School, Beijing; and
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Walter U, Müller JU, Rösche J, Kirsch M, Grossmann A, Benecke R, Wittstock M, Wolters A. Magnetic resonance-transcranial ultrasound fusion imaging: A novel tool for brain electrode location. Mov Disord 2015; 31:302-9. [PMID: 26362398 DOI: 10.1002/mds.26425] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 08/07/2015] [Accepted: 08/09/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A combination of preoperative magnetic resonance imaging (MRI) with real-time transcranial ultrasound, known as fusion imaging, may improve postoperative control of deep brain stimulation (DBS) electrode location. Fusion imaging, however, employs a weak magnetic field for tracking the position of the ultrasound transducer and the patient's head. Here we assessed its feasibility, safety, and clinical relevance in patients with DBS. METHODS Eighteen imaging sessions were conducted in 15 patients (7 women; aged 52.4 ± 14.4 y) with DBS of subthalamic nucleus (n = 6), globus pallidus interna (n = 5), ventro-intermediate (n = 3), or anterior (n = 1) thalamic nucleus and clinically suspected lead displacement. Minimum distance between DBS generator and magnetic field transmitter was kept at 65 cm. The pre-implantation MRI dataset was loaded into the ultrasound system for the fusion imaging examination. The DBS lead position was rated using validated criteria. Generator DBS parameters and neurological state of patients were monitored. RESULTS Magnetic resonance-ultrasound fusion imaging and volume navigation were feasible in all cases and provided with real-time imaging capabilities of DBS lead and its location within the superimposed magnetic resonance images. Of 35 assessed lead locations, 30 were rated optimal, three suboptimal, and two displaced. In two cases, electrodes were re-implanted after confirming their inappropriate location on computed tomography (CT) scan. No influence of fusion imaging on clinical state of patients, or on DBS implantable pulse generator function, was found. CONCLUSIONS Magnetic resonance-ultrasound real-time fusion imaging of DBS electrodes is safe with distinct precautions and improves assessment of electrode location. It may lower the need for repeated CT or MRI scans in DBS patients.
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Affiliation(s)
- Uwe Walter
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Jan-Uwe Müller
- Department of Neurosurgery, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - Johannes Rösche
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Michael Kirsch
- Institute of Diagnostic Radiology and Neuroradiology, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - Annette Grossmann
- Institute of Diagnostic and Interventional Radiology, University of Rostock, Rostock, Germany
| | - Reiner Benecke
- Department of Neurology, University of Rostock, Rostock, Germany
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Van Den Berge N, Vanhove C, Descamps B, Dauwe I, van Mierlo P, Vonck K, Keereman V, Raedt R, Boon P, Van Holen R. Functional MRI during Hippocampal Deep Brain Stimulation in the Healthy Rat Brain. PLoS One 2015; 10:e0133245. [PMID: 26193653 PMCID: PMC4508110 DOI: 10.1371/journal.pone.0133245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/24/2015] [Indexed: 01/12/2023] Open
Abstract
Deep Brain Stimulation (DBS) is a promising treatment for neurological and psychiatric disorders. The mechanism of action and the effects of electrical fields administered to the brain by means of an electrode remain to be elucidated. The effects of DBS have been investigated primarily by electrophysiological and neurochemical studies, which lack the ability to investigate DBS-related responses on a whole-brain scale. Visualization of whole-brain effects of DBS requires functional imaging techniques such as functional Magnetic Resonance Imaging (fMRI), which reflects changes in blood oxygen level dependent (BOLD) responses throughout the entire brain volume. In order to visualize BOLD responses induced by DBS, we have developed an MRI-compatible electrode and an acquisition protocol to perform DBS during BOLD fMRI. In this study, we investigate whether DBS during fMRI is valuable to study local and whole-brain effects of hippocampal DBS and to investigate the changes induced by different stimulation intensities. Seven rats were stereotactically implanted with a custom-made MRI-compatible DBS-electrode in the right hippocampus. High frequency Poisson distributed stimulation was applied using a block-design paradigm. Data were processed by means of Independent Component Analysis. Clusters were considered significant when p-values were <0.05 after correction for multiple comparisons. Our data indicate that real-time hippocampal DBS evokes a bilateral BOLD response in hippocampal and other mesolimbic structures, depending on the applied stimulation intensity. We conclude that simultaneous DBS and fMRI can be used to detect local and whole-brain responses to circuit activation with different stimulation intensities, making this technique potentially powerful for exploration of cerebral changes in response to DBS for both preclinical and clinical DBS.
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Affiliation(s)
- Nathalie Van Den Berge
- Medical Image and Signal Processing Group, Ghent University-iMinds Medical IT department, Ghent, Belgium
- * E-mail:
| | - Christian Vanhove
- Medical Image and Signal Processing Group, Ghent University-iMinds Medical IT department, Ghent, Belgium
| | - Benedicte Descamps
- Medical Image and Signal Processing Group, Ghent University-iMinds Medical IT department, Ghent, Belgium
| | - Ine Dauwe
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Ghent University Hospital, Ghent, Belgium
| | - Pieter van Mierlo
- Medical Image and Signal Processing Group, Ghent University-iMinds Medical IT department, Ghent, Belgium
| | - Kristl Vonck
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Ghent University Hospital, Ghent, Belgium
| | - Vincent Keereman
- Medical Image and Signal Processing Group, Ghent University-iMinds Medical IT department, Ghent, Belgium
| | - Robrecht Raedt
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Ghent University Hospital, Ghent, Belgium
| | - Paul Boon
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Ghent University Hospital, Ghent, Belgium
| | - Roel Van Holen
- Medical Image and Signal Processing Group, Ghent University-iMinds Medical IT department, Ghent, Belgium
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Tronnier HT, Melchert U, Petersen D, Tronnier VM. Risk Assessment of Magnetic Resonance Imaging in Chronically Implanted Paddle Electrodes for Cortical Stimulation. Stereotact Funct Neurosurg 2015; 93:182-9. [DOI: 10.1159/000375175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 01/13/2015] [Indexed: 11/19/2022]
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Chabardes S, Isnard S, Castrioto A, Oddoux M, Fraix V, Carlucci L, Payen JF, Krainik A, Krack P, Larson P, Le Bas JF. Surgical implantation of STN-DBS leads using intraoperative MRI guidance: technique, accuracy, and clinical benefit at 1-year follow-up. Acta Neurochir (Wien) 2015; 157:729-37. [PMID: 25788414 DOI: 10.1007/s00701-015-2361-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/22/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Improvement of surgical accuracy during DBS-lead implantation has been described recently, leading to "frameless" or "MRI-verified" techniques. However, combining a high-quality definition of the STN using intraoperative 1.5 MRI with the possibility to reduce errors due to co-registration and to monitor lead progression during surgical insertion while checking the absence of surgical complication is an appealing method. We report here surgical methodology, safety, application accuracy, and clinical benefit of STN-lead implantation under MRI guidance. METHODS Two patients with a severe PD state were treated by bilateral STN-DBS. Leads were implanted under general anesthesia using intraoperative MRI guidance (ClearPoint system). Lead implantation accuracy was measured on T1 axial images at the level of the target. Clinical improvement was measured on the pre- and post-UPDRS 3 scale at 1-year follow-up. RESULTS Surgery was safe and uneventful in both cases. Radial error was 0.36 (right) and 0.86 mm (left) in case 1, and 0.41 (right) and 0.14 mm (left) in case 2. No edema or hemorrhage were noticed. CONCLUSIONS Intraoperative MRI guidance allows DBS lead implantation with high accuracy and with great clinical efficacy. A larger cohort of patients is needed to confirm these initial results.
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Affiliation(s)
- Stephan Chabardes
- Clinique de Neurochirurgie, Pole Tête, Cou et Chirurgie Réparatrice, CHU Michallon, Grenoble, France,
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Shi L, Yang AC, Meng DW, Li SW, Liu HG, Li JJ, Wang X, Zhang X, Zhang JG. Pathological alterations and stress responses near DBS electrodes after MRI scans at 7.0T, 3.0T and 1.5T: an in vivo comparative study. PLoS One 2014; 9:e101624. [PMID: 24988329 PMCID: PMC4079335 DOI: 10.1371/journal.pone.0101624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 06/09/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the pathological alterations and the stress responses around deep brain stimulation (DBS) electrodes after magnetic resonance imaging (MRI) scans at 7.0T, 3.0T and 1.5T. MATERIALS AND METHODS DBS devices were stereotactically implanted into the brains of New Zealand rabbits, targeting the left nucleus ventralis posterior thalami, while on the right side, a puncture passage pointing to the same target was made. MRI scans at 7.0T, 3.0T and 1.5T were performed using transmit/receive head coils. The pathological alterations of the surrounding tissue were evaluated by hematoxylin and eosin staining (H&E staining) and transmission electron microscopy (TEM). The levels of the 70 kDa heat shock protein (HSP-70), Neuronal Nuclei (NeuN) and Caspase-3 were determined by western-blotting and quantitative polymerase chain reaction (QPCR) to assess the stress responses near the DBS electrodes. RESULTS H&E staining and TEM showed that the injury around the DBS electrodes was featured by a central puncture passage with gradually weakened injurious alterations. Comparisons of the injury across the groups manifested similar pathological alterations near the DBS electrodes in each group. Moreover, western-blotting and QPCR assay showed that the level of HSP-70 was not elevated by MRI scans (p>0.05), and the levels of NeuN and Caspase-3 were equal in each group, regardless of the field strengths applied (p>0.05). CONCLUSIONS Based on these findings, it is reasonable to conclude that in this study the MRI scans at multiple levels failed to induce additional tissue injury around the DBS electrodes. These preliminary data furthered our understanding of MRI-related DBS heating and encouraged revisions of the current MRI guidelines for patients with DBS devices.
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Affiliation(s)
- Lin Shi
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - An-Chao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Da-Wei Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shao-Wu Li
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Huan-Guang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun-Ju Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, People's Hospital of Hainan Province, Haikou, Hainan Province, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Sarkar SN, Papavassiliou E, Rojas R, Teich DL, Hackney DB, Bhadelia RA, Stormann J, Alterman RL. Low-power inversion recovery MRI preserves brain tissue contrast for patients with Parkinson disease with deep brain stimulators. AJNR Am J Neuroradiol 2014; 35:1325-9. [PMID: 24676004 PMCID: PMC7966586 DOI: 10.3174/ajnr.a3896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/13/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Fast spin-echo short τ inversion recovery sequences have been very useful for MR imaging-guided deep brain stimulation procedures in Parkinson disease. However, high-quality fast spin-echo imaging deposits significant heat, exceeding FDA-approved limits when patients already have undergone deep brain stimulation and need a second one or a routine brain MR imaging for neurologic indications. We have developed a STIR sequence with an ultra-low specific absorption rate that meets hardware limitations and produces adequate tissue contrast in cortical and subcortical brain tissues for deep brain stimulation recipients. MATERIALS AND METHODS Thirteen patients with medically refractory Parkinson disease who qualified for deep brain stimulation were imaged at 1.5T with a fast spin-echo short τ inversion recovery sequence modified to meet conditional MR imaging hardware and specific absorption rate restrictions. Tissue contrast-to-noise ratios and implant localization were objectively and subjectively compared by 2 neuroradiologists, and image quality for surgical planning was assessed by a neurosurgeon for high and low specific absorption rate images. RESULTS The mean contrast-to-noise ratio for cerebral tissues without including the contrast-to-noise ratio for ventricular fluid was 35 and 31 for high and low specific absorption rate images. Subjective ratings for low specific absorption rate tissue contrast in 77% of patients were identical to (and in a few cases higher than) those of high specific absorption rate contrast, while the neurosurgical coordinates for fusing the stereotactic atlas with low specific absorption rate MR imaging were equivalent to those of the high specific absorption rate for 69% of patients. CONCLUSIONS Patients with Parkinson disease who have already had a deep brain stimulation face a risk of neural injury if routine, high specific absorption rate MR imaging is performed. Our modified fast spin-echo short τ inversion recovery sequence conforms to very conservative radiofrequency safety limits, while it maintains high tissue contrast for presurgical planning, postsurgical assessment, and radiologic evaluations with greater confidence for radiofrequency safety.
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Affiliation(s)
- S N Sarkar
- From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.)
| | - E Papavassiliou
- Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - R Rojas
- From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.)
| | - D L Teich
- From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.)
| | - D B Hackney
- From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.)
| | - R A Bhadelia
- From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.)
| | - J Stormann
- From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.)
| | - R L Alterman
- Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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