1
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Bluhm R, Cortright M, Achtyes ED, Cabrera LY. "They Are Invasive in Different Ways.": Stakeholders' Perceptions of the Invasiveness of Psychiatric Electroceutical Interventions. AJOB Neurosci 2023; 14:1-12. [PMID: 34387539 PMCID: PMC10424189 DOI: 10.1080/21507740.2021.1958098] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Medical interventions are usually categorized as "invasive" when they involve piercing the skin or inserting an object into the body. Beyond this standard definition, however, there is little discussion of the concept of invasiveness in the medical literature, despite evidence that the term is used in ways that do not reflect the standard definition of medical invasiveness. We interviewed psychiatrists, patients with depression, and members of the public without depression to better understand their views on the invasiveness of several psychiatric electroceutical interventions (treatments that involve electrical or magnetic stimulation of the brain) for the treatment of depression. Our study shows that people recognize several kinds of invasiveness: physical, emotional, and lifestyle. In addition, several characteristics of therapies influence how invasive they are perceived to be; these include the perceived capacity of an intervention to result in harm; how localized the effects of the intervention are; the amount of control retained by the person receiving the intervention; how permanent its effects are perceived as being; and how familiar it seemed to participants. Our findings contribute to a small literature on the concept of invasiveness, which emphasizes that categorizing an intervention as invasive, or as noninvasive, evokes a variety of other normative considerations, including the potential harm it poses and how it compares to other potential therapies. It may also draw attention away from other salient features of the intervention.
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Affiliation(s)
| | | | - Eric D. Achtyes
- Michigan State University
- Pine Rest Christian Mental Health Services
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2
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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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3
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Shaikh N, Sinan M, Volk G, Freiser ME, Coutras S, Makary C. Hypoglossal Nerve Stimulator Failure from Electromagnetic Interference with Effective Lead Crossover. EAR, NOSE & THROAT JOURNAL 2022:1455613221086540. [PMID: 35321584 DOI: 10.1177/01455613221086540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Noah Shaikh
- Department of Otolaryngology-Head and Neck Surgery, 53422West Virginia University, Morgantown, WV, USA
| | - Moaz Sinan
- Department of Otolaryngology-Head and Neck Surgery, 53422West Virginia University, Morgantown, WV, USA
| | - Garrett Volk
- School of Medicine, 53422West Virginia University, Morgantown, WV, USA
| | - Monika E Freiser
- Department of Otolaryngology-Head and Neck Surgery, 53422West Virginia University, Morgantown, WV, USA
| | - Steven Coutras
- Department of Otolaryngology-Head and Neck Surgery, 53422West Virginia University, Morgantown, WV, USA
| | - Chadi Makary
- Department of Otolaryngology-Head and Neck Surgery, 53422West Virginia University, Morgantown, WV, USA
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4
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Torrey EF. Parkinson's: the weirdest disease. Psychol Med 2021; 51:727-730. [PMID: 33431089 DOI: 10.1017/s003329172000522x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- E Fuller Torrey
- Stanley Medical Research Institute, 10605 Concord St, Suite 206, Kensington, 20895, MD, USA
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5
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Rahimpour S, Kiyani M, Hodges SE, Turner DA. Deep brain stimulation and electromagnetic interference. Clin Neurol Neurosurg 2021; 203:106577. [PMID: 33662743 DOI: 10.1016/j.clineuro.2021.106577] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 01/08/2023]
Abstract
Deep brain stimulation (DBS) has evolved into an approved and efficacious treatment for movement, obsessive-compulsive, and epilepsy disorders that are refractory to medical therapy, with current investigation into other disease conditions. However, there are unintentional and intentional sources of external electromagnetic interference (EMI) that can lead to either malfunctioning or damaged DBS devices, as well as injury to human tissue. Comprehensive studies and guidelines on such topics in the medical literature are scarce. Herein, we review the principles behind EMI, as well as the various potential sources of interference, both unintentional (e.g. stray EMI fields) and intentional (e.g. MRI scans, "brainjacking"). Additionally, we employ the Manufacturer and User Device Facility Experience (MAUDE) database to assess real-world instances of EMI (e.g., airport body scanners, magnetic resonance imaging (MRI), and electrosurgery) affecting DBS devices commonly implanted in the United States (US).
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Affiliation(s)
- Shervin Rahimpour
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
| | - Musa Kiyani
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Sarah E Hodges
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Dennis A Turner
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA; Departments of Neurobiology and Biomedical Engineering, Duke University, Durham, NC USA
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6
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Baig F, Robb T, Mooney L, Robbins C, Norris C, Barua N, Szewczyk-Krolikowski K, Whone A. Deep brain stimulation: practical insights and common queries. Pract Neurol 2019; 19:502-507. [PMID: 31358573 DOI: 10.1136/practneurol-2019-002275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2019] [Indexed: 11/03/2022]
Abstract
The number of patients with deep brain stimulation (DBS) devices implanted is increasing. Although practices vary between centres, patients are typically given training and information from their DBS nurse or clinician, as well as a comprehensive device manual and contact details for their device manufacturer. However, for the lifetime of a patient with a DBS system, most of their secondary care often occurs in a centre without a co-located DBS service. The local neurologist is often asked pragmatic questions regarding the do's and don'ts for patients with DBS systems. While a DBS centre or device manufacturer can provide advice, we thought that it will be helpful to outline the overall management of DBS for movement disorders and the approach to commonly raised questions. We describe briefly the clinical application of DBS and discuss common scenarios where there are possible compatibility issues around the device.
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Affiliation(s)
- Fahd Baig
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Thomas Robb
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Lucy Mooney
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Caroline Robbins
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Caroline Norris
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Neil Barua
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Translational Health Sciences, University of Bristol, Bristol, UK
| | - Konrad Szewczyk-Krolikowski
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Alan Whone
- Neurological and Musculoskeletal Sciences Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK .,Translational Health Sciences, University of Bristol, Bristol, UK
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7
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Tipper G, Ali Taqvi A, Singh A, Pohl U, Low H. The local thermal effect of using monopolar electrosurgery in the presence of a deep brain stimulator: Cadaveric studies on a lamb brain. J Clin Neurosci 2019; 65:134-139. [PMID: 30852074 DOI: 10.1016/j.jocn.2019.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/26/2019] [Accepted: 02/20/2019] [Indexed: 11/27/2022]
Abstract
In 2001, a patient with a deep brain stimulator (DBS) died following treatment with medical diathermy. Manufacturers have since advised against all forms of diathermy except bipolar electrosurgery in DBS patients. This effective ban on monopolar electrosurgery has an impact on the 150,000 patients treated with DBS to date, a number that is set to progressively increase. Analysis of the events, technical specifications, and literature suggests that the original ban was based on extrapolation from medical diathermy to electrosurgery, two very different treatment modalities. This prompted novel work exploring the impact of electrosurgery on DBS systems. Monopolar electrosurgery was employed on an animal cadaveric model with a DBS system paired with a thermocouple at the brain implant site. Prolonged use of monopolar, including at settings higher than normal surgical practice, resulted in a maximum mean temperature increase of only 2.6 °C. Microscopic post-event analysis showed no evidence of thermal injury at the implant site. The implication is that there may be limits within which monopolar electrosurgery use is safe in patients with DBS.
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Affiliation(s)
- Geoffrey Tipper
- Department of Neurosciences, Queens Hospital, Romford, Essex RM7 0AG, UK.
| | - Ahsan Ali Taqvi
- Department of Neurosciences, Queens Hospital, Romford, Essex RM7 0AG, UK
| | - Arvind Singh
- Department of Neurosciences, Queens Hospital, Romford, Essex RM7 0AG, UK
| | - Ute Pohl
- Department of Neurosciences, Queens Hospital, Romford, Essex RM7 0AG, UK
| | - HuLiang Low
- Department of Neurosciences, Queens Hospital, Romford, Essex RM7 0AG, UK
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8
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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 2018; 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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9
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Allert N, Barbe MT, Timmermann L, Coenen VA. Rapid battery depletion and loss of therapy due to a short circuit in bipolar DBS for essential tremor. Acta Neurochir (Wien) 2017; 159:795-798. [PMID: 28130602 DOI: 10.1007/s00701-017-3090-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
Technical dysfunctions have been reported reducing efficacy of deep brain stimulation (DBS). Here, we report on an essential-tremor patient in whom a short circuit in bipolar DBS resulted not only in unilateral loss of therapy but also in high current flow and thereby rapid decline of the impulse-generator battery voltage from 2.83 V a week before the event to 2.54 V, indicating the need for an impulse-generator replacement. Immediate re-programming restored therapeutic efficacy. Moreover, the reduction in current flow allowed the battery voltage to recover without immediate surgical intervention to 2.81 V a week later.
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10
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Fang JY, Tolleson C. The role of deep brain stimulation in Parkinson's disease: an overview and update on new developments. Neuropsychiatr Dis Treat 2017; 13:723-732. [PMID: 28331322 PMCID: PMC5349504 DOI: 10.2147/ndt.s113998] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by the loss of neuronal dopamine production in the brain. Oral therapies primarily augment the dopaminergic pathway. As the disease progresses, more continuous delivery of therapy is commonly needed. Deep brain stimulation (DBS) has become an effective therapy option for several different neurologic and psychiatric conditions, including PD. It currently has US Food and Drug Administration approval for PD and essential tremor, as well as a humanitarian device exception for dystonia and obsessive-compulsive disorder. For PD treatment, it is currently approved specifically for those patients suffering from complications of pharmacotherapy, including motor fluctuations or dyskinesias, and a disease process of at least 4 years of duration. Studies have demonstrated superiority of DBS and medical management compared to medical management alone in selected PD patients. Optimal patient selection criteria, choice of target, and programming methods for PD and the other indications for DBS are important topics that continue to be explored and remain works in progress. In addition, new hardware options, such as different types of leads, and different software options have recently become available, increasing the potential for greater efficacy and/or reduced side effects. This review gives an overview of therapeutic management in PD, specifically highlighting DBS and some of the recent changes with surgical therapy.
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Affiliation(s)
- John Y Fang
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christopher Tolleson
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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11
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A Canadian Winter Indirectly Inactivates a Deep Brain Stimulation System. Can J Neurol Sci 2016; 44:332-333. [PMID: 27993176 DOI: 10.1017/cjn.2016.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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Allert N, Reyes Santana M, Karbe H. Short Circuit in Deep Brain Stimulation for Parkinson's Disease Mimicking Stroke. Brain Stimul 2016; 9:950-951. [PMID: 27651235 DOI: 10.1016/j.brs.2016.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Niels Allert
- Neurological Rehabilitation Center Godeshoehe, Waldstrasse 2-10, D-53177 Bonn, Germany.
| | - Marta Reyes Santana
- Neurological Rehabilitation Center Godeshoehe, Waldstrasse 2-10, D-53177 Bonn, Germany
| | - Hans Karbe
- Neurological Rehabilitation Center Godeshoehe, Waldstrasse 2-10, D-53177 Bonn, Germany
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13
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Guinand A, Noble S, Frei A, Renard J, Tramer MR, Burri H. Extra-cardiac stimulators: what do cardiologists need to know? Europace 2016; 18:1299-307. [DOI: 10.1093/europace/euv453] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/23/2015] [Indexed: 01/25/2023] Open
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14
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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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15
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Chen S, Li Q, Wang W, Ma B, Hao H, Li L. In Vivo Experimental Study of Thermal Problems for Rechargeable Neurostimulators. Neuromodulation 2013; 16:436-41; discussion 441-2. [DOI: 10.1111/ner.12044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 01/09/2013] [Accepted: 01/17/2013] [Indexed: 11/29/2022]
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16
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Rose NGW, Mostrenko M, McMaster J, Honey CR. Severe agitation following deep brain stimulation for parkinsonism. CAN J EMERG MED 2011; 13:279-83, E11-2. [PMID: 21722545 DOI: 10.2310/10.2310/8000.2011.110001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The use of deep brain stimulation has become increasingly common for the treatment of movement disorders, including Parkinson disease. Although deep brain stimulation is generally very successful in alleviating the extrapyramidal symptoms of Parkinson disease, side effects can occur. This case report describes a patient presenting to the emergency department in a state of extreme aggression 3 days after a change in the parameters of his bilateral subthalamic nucleus stimulator. We review the complications of deep brain stimulation relevant to the emergency physician and provide some practical information on stimulator adjustment in an emergency.
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Affiliation(s)
- Nicholas G W Rose
- Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
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17
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Sommerfield D, Hu P, O’Keeffe D, McKeatinga K. Caesarean section in a parturient with a spinal cord stimulator. Int J Obstet Anesth 2010; 19:114-7. [DOI: 10.1016/j.ijoa.2009.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 05/19/2009] [Accepted: 08/25/2009] [Indexed: 12/17/2022]
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