1
|
Matsuda Y, Masuda M, Asai M, Iida O, Mano T. Cryoballoon ablation and cardioversion using intracardiac defibrillation catheter for atrial fibrillation in a patient with deep brain stimulation. J Cardiol Cases 2023; 27:241-244. [PMID: 37180222 PMCID: PMC10173394 DOI: 10.1016/j.jccase.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
Deep brain stimulation (DBS) is a well-established therapy for drug-refractory Parkinson's disease. As 100-200 Hz signals from DBS are transmitted from the generator implanted subcutaneously in the anterior chest wall, there is a risk of central nervous system damage by radiofrequency energy or cardioversion. A 76-year-old female with a DBS was admitted for catheter ablation because of palpitation and syncope by paroxysmal atrial fibrillation. There may have been a risk of central nervous system damage and DBS electrode malfunction by radiofrequency energy and defibrillation shocks. In addition, cardioversion by an external defibrillator had the possibility to cause brain injury in patients with DBS. Therefore, pulmonary vein isolation by cryoballoon and cardioversion using an intracardiac defibrillation catheter were performed. Despite continued application of DBS during the procedure, no complications occurred. This is the first case report of cryoballoon ablation accompanied with intracardiac defibrillation under continued DBS. Cryoballoon ablation may be an alternative atrial fibrillation ablation method to radiofrequency catheter ablation for patients with DBS. Additionally, intracardiac defibrillation may reduce the risk of central nervous system damage and DBS malfunction. Learning objective Deep brain stimulation (DBS) is a well-established therapy for Parkinson's disease. In patients with DBS, there is a risk of central nervous system damage by radiofrequency energy or cardioversion by an external defibrillator. Cryoballoon ablation may be an alternative atrial fibrillation ablation method to radiofrequency catheter ablation for patients with continued DBS. In addition, intracardiac defibrillation may reduce the risk of central nervous system damage and DBS malfunction.
Collapse
|
2
|
Bukowski N, Laurin A, Laforgue EJ, Preterre C, Rouaud T, Damier P, Raoul S, Dumont R, Loutrel O, Guitteny M, Derkinderen P, Bulteau S, Sauvaget A. Efficacy and Safety of Electroconvulsive Therapy in Patients With Deep Brain Stimulation: Literature Review, Case Report for Patient With Essential Tremor, and Practical Recommendations. J ECT 2022; 38:e29-e40. [PMID: 36018735 DOI: 10.1097/yct.0000000000000828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Deep brain stimulation (DBS) has proven to be an effective therapy of some treatment-resistant psychiatric disorders and movement disorders. Comorbid depressive symptoms are common and difficult to manage. Treatment with electroconvulsive therapy (ECT) may be required. There are few published cases describing the safety and efficacy of ECT for patients with DBS implants, and there are no available guidelines for administration of ECT in patients with DBS and mood disorders. The current study had 3 aims: (i) to conduct a systematic review of case reports on patients with DBS implants who received ECT; (ii) to report the case of a 69-year-old man with a DBS implant for essential tremor, who required ECT; and (iii) to provide practical recommendations for ECT in patients with DBS implants. METHODS We conducted a systematic review, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, of existing case reports on patients with DBS implants administered ECT for psychiatric disorders. RESULTS Our search yielded 25 cases of ECT in patients implanted with DBS systems. In addition, we here describe successful ECT management of major depressive disorder in a patient treated by DBS. We also set forth ECT management guidelines based on points of consensus. The 2 most important practical recommendations are to make sure the DBS system is set to 0 V and turned off before ECT, and to avoid sites near the DBS electrodes. CONCLUSIONS Electroconvulsive therapy may be an effective and safe treatment for DBS patients with MDD.
Collapse
Affiliation(s)
- Nicolas Bukowski
- From the Addictology and Consultation-Liaison Psychiatry Department, CHU de Nantes
| | | | | | | | | | | | | | - Romain Dumont
- Department of Anesthesiology and Critical Care Medicine, Hôtel-Dieu-PTMC, CHU de Nantes, Nantes, France
| | - Olivier Loutrel
- Department of Anesthesiology and Critical Care Medicine, Hôtel-Dieu-PTMC, CHU de Nantes, Nantes, France
| | - Marie Guitteny
- From the Addictology and Consultation-Liaison Psychiatry Department, CHU de Nantes
| | | | | | | |
Collapse
|
3
|
Khattab MH, Cmelak AJ, Sherry AD, Luo G, Wang L, Yu H, Hedera P, Phibbs FT, Lindsell CJ, Neimat J, Kirschner AN. Noninvasive Thalamotomy for Refractory Tremor by Frameless Radiosurgery. Int J Radiat Oncol Biol Phys 2021; 112:121-130. [PMID: 34454047 DOI: 10.1016/j.ijrobp.2021.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We sought to determine whether a more widely accessible, non-invasive frameless approach to radiosurgical thalamotomy would improve objective measures of refractory essential or parkinsonian tremor without added toxicity compared to reports of frame-based radiosurgery. METHODS We conducted a single-arm pilot observational prospective trial of adult patients with essential or parkinsonian tremor from 2013 to 2019 and report results at one-year follow-up. Patients were treated with frameless unilateral radiosurgical ablation of the thalamic ventral intermediate nucleus to a maximum dose of 160 Gy. Treatment response was measured by the Fahn-Tolosa-Marin (FTM) tremor rating scale and the Quality of Life in Essential Tremor or Parkinson's Disease Questionnaire obtained prior to treatment and at 3, 6, 9, and 12 months. RESULTS Thirty-three patients, including 23 with essential tremor and 10 with Parkinson's disease, were enrolled. Overall treatment response rate per FTM was 83% (n=15/18) at 6 months. There was a marked improvement in tremor, with average total FTM reduction of 21% at 3 months (from 46 to 30 points, p=0.003) and 41% at 6 months (from 46 to 24 points, p=0.001). At 6 months, functional decline had regressed by 54% (from 15 to 7 points, p=0.001). Quality of life improved by 57% (p=0.001) at 6 months in patients with essential tremor, and patients with Parkinson's Disease had unchanged quality of life. At one-year follow-up, grade 2 neurologic adverse events were observed in 6% (n=2/33) of patients without any grade ≥ 3 events. CONCLUSION Noninvasive, frameless radiosurgical thalamotomy may be a feasible treatment for patients with refractory tremor and demonstrates short-term safety at one-year follow-up. This pilot study provides promising preliminary descriptions of efficacy, and definitive estimates of long-term safety and benefit require further study with longer follow-up.
Collapse
Affiliation(s)
- Mohamed H Khattab
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN.
| | - Anthony J Cmelak
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Alexander D Sherry
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Guozhen Luo
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Hong Yu
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Peter Hedera
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN; Department of Neurology, University of Louisville School of Medicine, Louisville, KY
| | - Fenna T Phibbs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Joseph Neimat
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY
| | - Austin N Kirschner
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
4
|
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).
Collapse
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
| |
Collapse
|
5
|
Davis G, Levine Z. Deep Brain Stimulation Generator Failure due to External Defibrillation in a Patient with Essential Tremor. Stereotact Funct Neurosurg 2020; 99:38-39. [PMID: 33070142 DOI: 10.1159/000510122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 07/13/2020] [Indexed: 11/19/2022]
Abstract
There exist only two case reports to date of open cardiac defibrillation with deep brain stimulator system (DBS) implantation. We report a 64-year-old male with DBS system in place for essential tremor who underwent cardiac defibrillation after cardiac arrest. Afterwards, his device impedances were all high and his tremor symptoms returned. Both problems resolved with implantation of a new generator and required no changes to the intracranial leads or extension cables. This is significantly different from the two previous reports. One included a significantly different DBS system relying on transcutaneous RF transmission and reported a lesioning effect after cardioversion. The other utilized a modern DBS system but reported damage to the generator and intracranial leads. We report that only the generator sustained damage, and that there were no intracranial changes that occurred.
Collapse
Affiliation(s)
- Gregory Davis
- Department of Neurological Surgery, George Washington University Hospital, Washington, District of Columbia, USA,
| | - Zachary Levine
- Department of Neurological Surgery, George Washington University Hospital, Washington, District of Columbia, USA.,Department of Neurological Surgery, Holy Cross Hospital, Forest Glen, Maryland, USA
| |
Collapse
|
6
|
Heard T, Coyne T, Silburn P. Deep Brain Stimulation in Patients With Concomitant Cardiac Pacemakers: A Case Series. Oper Neurosurg (Hagerstown) 2020; 17:549-553. [PMID: 30851040 DOI: 10.1093/ons/opz018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 02/03/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is a treatment modality increasingly utilized in the management of neurological and psychiatric conditions. Neurosurgical technical considerations and contraindications have yet to be thoroughly characterized in the literature. The patient population for DBS includes many elderly patients with multiple comorbidities who require treatments and investigations that expose them to electromagnetic fields of varying strengths and durations, including other implanted electromodulatory devices. OBJECTIVE To determine if clinically significant interference arises between DBS and cardiac pacemaker systems. METHODS Here we audited 8 patients, mean age 72, with cardiac pacemakers and DBS implanted from 2007 to 2015. We investigated details of their neurological and electrocardiological treatment and progress and sought evidence for interference between the two systems. RESULTS We found no evidence of DBS dysfunction, and only one case of abnormal pacemaker interrogation 2 yr post-DBS implantation was found, which was thought to be secondary to a medication issue rather than neuromodulation interference. CONCLUSION Our research reassures the clinician that pacemakers and DBS systems do not appear to affect one another and provides guidance on minimizing possibility of this.
Collapse
Affiliation(s)
| | | | - Peter Silburn
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, University of Queensland, Brisbane, Australia
| |
Collapse
|
7
|
|
8
|
Grabie M, Gabriels J, Xiang K, Elayi CS, Makaryus JN, Catanzaro JN. Feasibility of radiofrequency catheter ablation in a patient with deep brain stimulators. HeartRhythm Case Rep 2020; 6:253-255. [PMID: 32461888 PMCID: PMC7244632 DOI: 10.1016/j.hrcr.2020.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Mordechai Grabie
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - James Gabriels
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Kun Xiang
- Department of Electrophysiology, University of Florida, Jacksonville, Florida
| | - Claude S Elayi
- Department of Electrophysiology, University of Florida, Jacksonville, Florida
| | - John N Makaryus
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York.,The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - John N Catanzaro
- Department of Electrophysiology, University of Florida, Jacksonville, Florida
| |
Collapse
|
9
|
The Safety of Electroconvulsive Therapy in Patients With Implanted Deep Brain Stimulators: A Review of the Literature and Case Report. J ECT 2019; 35:84-90. [PMID: 30407933 DOI: 10.1097/yct.0000000000000554] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Currently there is no consensus statement about the safety of electroconvulsive therapy in patients who have implanted electrodes for deep brain stimulation. We present a summary of the existing literature on this topic, consisting of 21 cases, and then report a case performed at the University of Maryland Medical Center. Notably, with appropriate safety precautions and careful patient selection, there were no adverse events reported in the literature that were related to the presence of the deep brain stimulation device in any of the cases. Based on our review of the literature and the case we present, we have found no evidence so far to indicate that electroconvulsive therapy in patients with an implanted deep brain stimulator is unsafe.
Collapse
|
10
|
Martínez-Moreno NE, Sahgal A, De Salles A, Hayashi M, Levivier M, Ma L, Paddick I, Régis J, Ryu S, Slotman BJ, Martínez-Álvarez R. Stereotactic radiosurgery for tremor: systematic review. J Neurosurg 2019; 130:589-600. [PMID: 29473775 DOI: 10.3171/2017.8.jns17749] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/15/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this systematic review is to offer an objective summary of the published literature relating to stereotactic radiosurgery (SRS) for tremor and consensus guideline recommendations. METHODS This systematic review was performed up to December 2016. Article selection was performed by searching the MEDLINE (PubMed) and EMBASE electronic bibliographic databases. The following key words were used: "radiosurgery" and "tremor" or "Parkinson's disease" or "multiple sclerosis" or "essential tremor" or "thalamotomy" or "pallidotomy." The search strategy was not limited by study design but only included key words in the English language, so at least the abstract had to be in English. RESULTS A total of 34 full-text articles were included in the analysis. Three studies were prospective studies, 1 was a retrospective comparative study, and the remaining 30 were retrospective studies. The one retrospective comparative study evaluating deep brain stimulation (DBS), radiofrequency thermocoagulation (RFT), and SRS reported similar tremor control rates, more permanent complications after DBS and RFT, more recurrence after RFT, and a longer latency period to clinical response with SRS. Similar tremor reduction rates in most of the reports were observed with SRS thalamotomy (mean 88%). Clinical complications were rare and usually not permanent (range 0%-100%, mean 17%, median 2%). Follow-up in general was too short to confirm long-term results. CONCLUSIONS SRS to the unilateral thalamic ventral intermediate nucleus, with a dose of 130-150 Gy, is a well-tolerated and effective treatment for reducing medically refractory tremor, and one that is recommended by the International Stereotactic Radiosurgery Society.
Collapse
Affiliation(s)
- Nuria E Martínez-Moreno
- 1Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - Arjun Sahgal
- 2Department of Radiation Oncology, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Antonio De Salles
- 3Department of Neurosurgery, University of California, Los Angeles, California
| | - Motohiro Hayashi
- 4Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Marc Levivier
- 5Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Lijun Ma
- 6Division of Physics, Department of Radiation Oncology, University of California, San Francisco, California
| | - Ian Paddick
- 7Division of Physics, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jean Régis
- 8Department of Functional Neurosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Sam Ryu
- 9Department of Radiation Oncology, Stony Brook University, Stony Brook, New York; and
| | - Ben J Slotman
- 10Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Roberto Martínez-Álvarez
- 1Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| |
Collapse
|
11
|
McClelland S, Henrikson CA, Ciporen JN, Jaboin JJ, Mitin T. Tumor Treating Fields Utilization in a Glioblastoma Patient with a Preexisting Cardiac Pacemaker: The First Reported Case. World Neurosurg 2018; 119:58-60. [PMID: 30064027 DOI: 10.1016/j.wneu.2018.07.162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tumor-treating fields (TTFs) have become an important, evidence-based modality in the treatment of glioblastoma (GBM). In patients requiring cardiac pacemakers, TTF therapy is complicated by theoretical concerns regarding possible electrical interaction between the devices. CASE DESCRIPTION A 57-year-old man with past medical history of sick sinus syndrome requiring cardiac pacemaker implantation suffered an acute neurologic change associated with a left parieto-occipital lesion, which was found to be GBM. After completion of guideline-concordant chemoradiation, he chose to undergo TTF therapy. Because of the absence of cardiac symptoms and the theoretical risk of far-field sensing by the pacemaker of the TTF device (potentially resulting in pacemaker inhibition), the pacemaker was turned off before receiving TTF. Following TTF implementation, the patient responded well; he remains alive more than 25 months following his GBM diagnosis, exceeding the median 20.9-month survival of the recently completed phase III TTF randomized clinical trial for newly diagnosed GBM. Furthermore, he has exhibited neither cardiac morbidity nor adverse scalp reactions to TTF therapy. CONCLUSIONS The first reported case of successful TTF administration in a GBM patient with a previously implanted cardiac pacemaker may allay the concerns of neuro-oncologists, cardiologists, radiation oncologists, and all certified TTF prescribers regarding the applicability of TTF in suitable candidates with preexisting cardiac pacemakers. This case indicates that TTF therapy may be efficacious in patients with indwelling magnetic resonance image-conditional cardiac pacemakers turned to the off position and that physical removal of the pacemaker is not necessary before starting TTF.
Collapse
Affiliation(s)
- Shearwood McClelland
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA; Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA.
| | - Charles A Henrikson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeremy N Ciporen
- Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Timur Mitin
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
12
|
A Submammarian Approach for Cosmetically Improved Implantation of Deep Brain Stimulation Generators. World Neurosurg 2018; 109:e699-e706. [DOI: 10.1016/j.wneu.2017.10.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 11/23/2022]
|
13
|
Sobstyl M, Michałowska M, Fiszer U, Ząbek M. Deep brain stimulation failure due to external cardioversion in a patient with Parkinson's disease. Neurol Neurochir Pol 2017; 51:324-330. [DOI: 10.1016/j.pjnns.2017.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 05/10/2017] [Accepted: 05/20/2017] [Indexed: 11/28/2022]
|
14
|
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
|
15
|
Buell TJ, Ksendzovsky A, Shah BB, Kesser BW, Elias WJ. Deep Brain Stimulation in the Setting of Cochlear Implants: Case Report and Literature Review. Stereotact Funct Neurosurg 2015; 93:245-9. [PMID: 25998722 DOI: 10.1159/000380824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 02/10/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS As technology continues to advance for our aging population, an increasing number of deep brain stimulation (DBS) candidates will have preexisting implanted electrical devices. In this article, we discuss safe and successful DBS in a patient with Parkinson's disease (PD) and bilateral cochlear implants. METHODS A 70-year-old male with PD and bilateral cochlear implants underwent successful microelectrode-guided DBS implantation into bilateral subthalamic nuclei (STN). The patient's cochlear implant magnets were removed and replaced in the outpatient clinic for preoperative MRI and stereotactic targeting. The cochlear implants were turned off intraoperatively for STN microelectrode recordings. RESULTS Precise, MRI-guided stereotactic DBS implantation was possible. Intraoperative high-fidelity microelectrode recordings confirmed STN neurons with the cochlear implants turned off. These recordings were not possible with active cochlear implant devices. Our literature review describes the other approaches/techniques that have been used to manage DBS surgery in the setting of cochlear implants. CONCLUSIONS Despite the risk of electrical interference between implanted medical devices, DBS and cochlear implants may be safe and compatible in the same patient if necessary precautions are taken.
Collapse
Affiliation(s)
- Thomas J Buell
- Department of Neurosurgery, University of Virginia, Charlottesville, Va., USA
| | | | | | | | | |
Collapse
|
16
|
Catatonia after deep brain stimulation successfully treated with lorazepam and right unilateral electroconvulsive therapy: a case report. J ECT 2014; 30:e13-5. [PMID: 23859977 PMCID: PMC3855084 DOI: 10.1097/yct.0b013e31829e0afa] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The presence of a deep brain stimulator (DBS) in a patient who develops neuropsychiatric symptoms poses unique diagnostic challenges and questions for the treating psychiatrist. Catatonia has been described only once, during DBS implantation, but has not been reported in a successfully implanted DBS patient. METHODS We present a case of a patient with bipolar disorder and renal transplant who developed catatonia after DBS for essential tremor. RESULTS The patient was successfully treated for catatonia with lorazepam and electroconvulsive therapy after careful diagnostic workup. Electroconvulsive therapy has been successfully used with DBS in a handful of cases, and certain precautions may help reduce potential risk. CONCLUSIONS Catatonia is a rare occurrence after DBS but when present may be safely treated with standard therapies such as lorazepam and electroconvulsive therapy.
Collapse
|
17
|
Quinn DK, Deligtisch A, Rees C, Brodsky A, Evans D, Khafaja M, Abbott CC. Differential diagnosis of psychiatric symptoms after deep brain stimulation for movement disorders. Neuromodulation 2014; 17:629-36; discussion 636. [PMID: 24512146 DOI: 10.1111/ner.12153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 11/28/2013] [Accepted: 12/12/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The presence of a deep brain stimulator (DBS) in a patient with a movement disorder who develops psychiatric symptoms poses unique diagnostic and therapeutic challenges for the treating clinician. Few sources discuss approaches to diagnosing and treating these symptoms. MATERIALS AND METHODS The authors review the literature on psychiatric complications in DBS for movement disorders and propose a heuristic for categorizing symptoms according to their temporal relationship with the DBS implantation process. RESULTS Psychiatric symptoms after DBS can be categorized as preimplantation, intra-operative/perioperative, stimulation related, device malfunction, medication related, and chronic stimulation related/long term. Once determined, the specific etiology of a symptom guides the practitioner in treatment. CONCLUSIONS A structured approach to psychiatric symptoms in DBS patients allows practitioners to effectively diagnose and treat them when they arise.
Collapse
Affiliation(s)
- Davin K Quinn
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | | | | | | | | | | |
Collapse
|
18
|
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.
Collapse
Affiliation(s)
- Nicholas G W Rose
- Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
| | | | | | | |
Collapse
|
19
|
Weise LM, Schneider GH, Kupsch A, Haumesser J, Hoffmann KT. Postoperative MRI examinations in patients treated by deep brain stimulation using a non-standard protocol. Acta Neurochir (Wien) 2010; 152:2021-7. [PMID: 20644967 DOI: 10.1007/s00701-010-0738-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 07/05/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND MRI in patients bearing deep brain stimulation (DBS) electrodes may induce cerebral lesions due to electrode heating. To avoid neurological deficits related to MRI, post-operative MRI protocol was installed in our institution. However, our protocol comprised a higher specific absorption rate (SAR) and different positioning of lead excess than the later released electrode manufacturer's guidelines. The objective was to evaluate the safety using this protocol. METHODS Between January 2000 and May 2008, post-operative MRI was performed in all patients. In selected patients, additional MRI scans were performed with the implanted generator. MRI was acquired at 1.5 T with a RF transmit/receive head coil comprising a T2-weighted fast spin echo (FSE) and a T1-weighted inversion recovery FSE sequence. Local cranial SAR values measured up to 0.9 W/kg compared to the manufacturer's recommendation of 0.1 W/kg. Initial scans (1-7 days after surgery) were performed with externalized leads, long-term scans (>30 days after surgery) with a connected generator. New neurological deficits were assessed before and after MRI. Additional MRIs were compared to the initial postoperative MRI with emphasis on new lesions. RESULTS In 211 patients, 243 MRIs were performed, including 212 initial post-operative MRI. In 12% (n = 24), 31 additional MRI examinations for various clinical reasons were achieved. No patients demonstrated new neurological deficits during or after MRI acquisitions. CONCLUSIONS No complications were observed using this MRI protocol in DBS patients. Our results suggest that, within this setting, higher SAR values may be feasible for DBS patients than in the manufacturer's guidelines.
Collapse
|
20
|
Ooi YC, Falowski S, Wang D, Jallo J, Ho RT, Sharan A. Simultaneous Use of Neurostimulators in Patients With a Preexisting Cardiovascular Implantable Electronic Device. Neuromodulation 2010; 14:20-5; discussion 25-6. [DOI: 10.1111/j.1525-1403.2010.00314.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Deng ZD, Hardesty DE, Lisanby SH, Peterchev AV. Electroconvulsive therapy in the presence of deep brain stimulation implants: electric field effects. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:2049-2052. [PMID: 21096149 DOI: 10.1109/iembs.2010.5626517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The safety of electroconvulsive therapy (ECT) in patients who have deep brain stimulation (DBS) implants represents a significant clinical issue. A major safety concern is the presence of burr holes and electrode anchoring devices in the skull, which may alter the induced electric field distribution in the brain. We simulated the electric field using finite-element method in a five-shell spherical head model. Three DBS electrode anchoring techniques were modeled, including ring/cap, microplate, and burr-hole cover. ECT was modeled with bilateral (BL), right unilateral (RUL), and bifrontal (BF) electrode placements and with clinically-used stimulus current amplitude. We compared electric field strength and focality among the DBS implantation techniques and ECT electrode configurations. The simulation results show an increase in the electric field strength in the brain due to conduction through the burr holes, especially when the burr holes are not fitted with nonconductive caps. For typical burr hole placement for subthalamic nucleus DBS, the effect on the electric field strength and focality is strongest for BF ECT, which runs contrary to the belief that more anterior ECT electrode placements are safer in patients with DBS implants.
Collapse
Affiliation(s)
- Zhi-De Deng
- Department of Electrical Engineering, Columbia University / New York State Psychiatric Institute, NY 10032, USA.
| | | | | | | |
Collapse
|
22
|
Lee JY, Han JH, Kim HJ, Jeon BS, Kim DG, Paek SH. STN DBS of Advanced Parkinson's Disease Experienced in a Specialized Monitoring Unit with a Prospective Protocol. J Korean Neurosurg Soc 2008; 44:26-35. [PMID: 19096653 DOI: 10.3340/jkns.2008.44.1.26] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 07/07/2008] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE In the evaluation of patients with Parkinson's disease (PD), most neurologists only see their patients during a limited period of their fluctuating 24-hour-a-day lives. This study aimed to assess the short-term outcome of STN stimulation for patients with advanced PD evaluated in a 24-hour monitoring unit for movement disorder (MUMD) using a prospective protocol. METHODS Forty-two patients with advanced PD consecutively treated with bilateral STN stimulation using multi-channel microelectrode recording were included in this study. All patients were evaluated using a 24-hour MUMD with a video recording/editing system and were evaluated with a prospective protocol of the Unified Parkinson's Disease Rating Scale, Hoehn and Yahr Staging, Schwab and England Activities of Daily Living, levodopa equivalent daily dose (LEDD), Short Form-36 Health Survey, and neuropsychological tests. Magnetic resonance (MR) images of the brain were performed prior to and six months after surgery. RESULTS All patients were evaluated at three and six months after surgery. There was a rapid and significant improvement of the motor symptoms, especially in tremor and rigidity, after STN stimulation with low morbidity. Dyskinesia was markedly decreased with much lowered LEDD values by 50% after STN stimulation. 1.5T MR images were safely taken according to the manufacturer's guidelines at six months after surgery without any adverse effects in 41 patients treated with STN stimulations. CONCLUSION Evaluations in a 24-hour monitoring unit could reduce the dose of medication efficiently to an optimal level with patients'comfort and improve the clinical symptoms in harmony with STN stimulation.
Collapse
Affiliation(s)
- Ji Yeoun Lee
- Department of Neurosurgery, Cancer Research Institute, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
23
|
Abstract
We report the successful treatment of an episode of major depression with psychotic features with electroconvulsive therapy (ECT) in a 78-year-old woman with advanced Parkinson disease who had a left subthalamic nucleus deep-brain stimulator (DBS) in place. Electroconvulsive therapy effectively and safely treated the patient's depression without harming the patient or damaging the DBS hardware. We offer additional evidence about the safety and efficacy of electroconvulsive therapy in patients with DBS.
Collapse
|
24
|
Roark C, Whicher S, Abosch A. Reversible neurological symptoms caused by diathermy in a patient with deep brain stimulators: case report. Neurosurgery 2008; 62:E256; discussion E256. [PMID: 18300881 DOI: 10.1227/01.neu.0000311085.73519.b4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Diathermy is contraindicated in patients with implanted deep brain stimulation (DBS) electrodes. As the clinical applications for diathermy and the number of patients with DBS implants continue to grow, the opportunity for diathermy-induced complications in the population with DBS electrodes increases. We report a case of reversible neurological deficit in a patient who underwent diathermy 4 years after implantation of bilateral DBS leads. CLINICAL PRESENTATION A 58-year-old man with well-controlled symptoms of Parkinson's disease after the placement of bilateral DBS systems went to his primary care physician for the treatment of recurrent neck pain. A course of diathermy was prescribed, and after the second treatment, the patient developed double-vision and severe right-sided motor contractions. These symptoms resolved when he turned off the implanted pulse generators. INTERVENTION The implanted pulse generators were turned back on after several days, but the symptoms recurred within 48 hours. The voltages were therefore decreased, resulting in resolution of symptoms but suboptimal control of the Parkinson's disease. A magnetic resonance imaging scan of the brain showed a small amount of edema surrounding the contacts of the left-sided lead. A follow-up magnetic resonance imaging scan 4 weeks later disclosed interval reduction in the edema, and the patient was able to tolerate increased voltage without symptom recurrence. CONCLUSION This is the first reported case of reversible injury from diathermy in a patient with DBS implants. Neurosurgeons must continue to emphasize to their patients and to other practitioners treating this population that diathermy is contraindicated for those with DBS implants.
Collapse
Affiliation(s)
- Christopher Roark
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA
| | | | | |
Collapse
|
25
|
Blomstedt P, Jabre M, Bejjani BP, Koskinen LOD. Electromagnetic Environmental Influences on Implanted Deep Brain Stimulators. Neuromodulation 2006; 9:262-9. [DOI: 10.1111/j.1525-1403.2006.00068.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
26
|
Blomstedt P, Hariz MI. Are Complications Less Common in Deep Brain Stimulation than in Ablative Procedures for Movement Disorders? Stereotact Funct Neurosurg 2006; 84:72-81. [PMID: 16790989 DOI: 10.1159/000094035] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The side effects and complications of deep brain stimulation (DBS) and ablative lesions for tremor and Parkinson's disease were recorded in 256 procedures (129 DBS and 127 lesions). Perioperative complications (seizures, haemorrhage, confusion) were rare and did not differ between the two groups. The rate of hardware-related complications was 17.8%. In ventral intermediate (Vim) thalamotomies, the rate of side effects was 74.5%, in unilateral Vim-DBS 47.3%, while in 7 bilateral Vim-DBS 13 side effects occurred. Most of the side effects of Vim-DBS were reversible upon switching off, or altering, stimulation parameters. In unilateral pallidotomy, the frequency of side effects was 21.9%, while in bilateral staged pallidotomies it was 33.3%. Eight side effects occurred in 11 procedures with pallidal DBS. In 22 subthalamic nucleus DBS procedures, 23 side effects occurred, of which 8 were psychiatric or cognitive. Unilateral ablative surgery may not harbour more postoperative complications or side effects than DBS. Some of the side effects following lesioning are transient and most but not all DBS side effects are reversible. In the Vim DBS is safer than lesioning, while in the pallidum, unilateral lesions are well tolerated.
Collapse
Affiliation(s)
- Patric Blomstedt
- Department of Neurosurgery, University Hospital of Northern Sweden, Umeå, Sweden.
| | | |
Collapse
|
27
|
Rezai AR, Baker KB, Tkach JA, Phillips M, Hrdlicka G, Sharan AD, Nyenhuis J, Ruggieri P, Shellock FG, Henderson J. Is magnetic resonance imaging safe for patients with neurostimulation systems used for deep brain stimulation? Neurosurgery 2006; 57:1056-62; discussion 1056-62. [PMID: 16284576 DOI: 10.1227/01.neu.0000186935.87971.2a] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Ali R Rezai
- Center for Neurological Restoration, Department of Neurosurgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Chou KL, Hurtig HI, Jaggi JL, Baltuch GH, Pelchat RJ, Weintraub D. Electroconvulsive therapy for depression in a Parkinson's disease patient with bilateral subthalamic nucleus deep brain stimulators. Parkinsonism Relat Disord 2005; 11:403-6. [PMID: 15994113 DOI: 10.1016/j.parkreldis.2005.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Revised: 04/05/2005] [Accepted: 04/06/2005] [Indexed: 10/25/2022]
Abstract
We report a patient with advanced Parkinson's disease (PD) who developed a recurrence of major depression with psychotic features after bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) surgery. Electroconvulsive therapy (ECT) dramatically improved the depression without shifting electrode position or damaging the DBS hardware. This case suggests that ECT can be a safe and effective option for severe depression in PD patients treated with STN DBS.
Collapse
Affiliation(s)
- Kelvin L Chou
- Department of Clinical Neurosciences, Brown University Medical School, Providence, RI, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Capelle HH, Simpson RK, Kronenbuerger M, Michaelsen J, Tronnier V, Krauss JK. Long-term deep brain stimulation in elderly patients with cardiac pacemakers. J Neurosurg 2005; 102:53-9. [PMID: 15658096 DOI: 10.3171/jns.2005.102.1.0053] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. Deep brain stimulation (DBS) has become an accepted therapy for movement disorders such as Parkinson disease (PD) and essential tremor (ET), when these conditions are refractory to medical treatment. The presence of a cardiac pacemaker is still considered a contraindication for DBS in functional neurosurgery. The goal of this study was to evaluate the technical and clinical management of DBS for the treatment of movement disorders in elderly patients with cardiac pacemakers.
Methods. Six patients with cardiac pacemakers underwent clinical and cardiac examinations to analyze the safety of DBS in the treatment of movement disorders. Four patients suffered from advanced PD and two patients had ET. The mean age of these patients at surgery was 69.5 years (range 63–79 years). The settings of the pacemakers were programmed in a manner considered to minimize the chance of interference between the two systems.
There were no adverse events during surgery. Four patients underwent stimulation of the thalamic ventralis intermedius nucleus (VIM), and two patients stimulation of the subthalamic nucleus. In general, bipolar sensing was chosen for the cardiac pacemakers. In all but one patient the quadripolar DBS electrodes were programmed for bipolar stimulation. Several control electrocardiography studies, including 24-hour monitoring, did not show any interference between the two systems. At the time this paper was written the patients had been followed up for a mean of 25.3 months (range 4–48 months).
Conclusions. In certain conditions it is safe for patients with cardiac pacemakers to receive DBS for treatment of concomitant movement disorders. Cardiac pacemakers should not be viewed as a general contraindication for DBS in patients with movement disorders.
Collapse
|
30
|
Senatus PB, McClelland S, Ferris AD, Ford B, Winfield LM, Pullman SL, Yu Q, McKhann GM, Schneller SJ, Goodman RR. Implantation of bilateral deep brain stimulators in patients with Parkinson disease and preexisting cardiac pacemakers. J Neurosurg 2004; 101:1073-7. [PMID: 15597774 DOI: 10.3171/jns.2004.101.6.1073] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
✓ Deep brain stimulation (DBS) has become an important modality in the treatment of refractory Parkinson disease (PD). In patients with comorbid arrhythmias requiring cardiac pacemakers, DBS therapy is complicated by concerns over a possible electrical interaction between the devices (or with device programming) and the inability to use magnetic resonance imaging guidance for implantation. The authors report two cases of PD in which patients with preexisting cardiac pacemakers underwent successful implantation of bilateral DBS electrodes in the subthalamic nucleus (STN).
Each patient underwent computerized tomography—guided stereotactic frame—based placement of DBS electrodes with microelectrode recording. Both extension wires were passed from the right side of the head and neck (contralateral to the pacemaker) to place the cranial pulse generators subcutaneously in the left and right abdomen. The cranial pulse generators were placed farther than 6 in from the cardiac pacemaker and from each other to decrease the chance of interference between the devices during telemetry reprogramming.
Postoperative management involved brain stimulator programming sessions with simultaneous cardiological monitoring of pacemaker function and cardiac rhythm. No interference was noted at any time, and proper pacemaker function was maintained throughout the follow-up period. With bilateral STN stimulation, both patients experienced a dramatic improvement in their PD symptoms, including elimination of dyskinesias, reduction of “off” severity, and increase of “on” duration.
With some modifications of implantation strategy, two patients with cardiac pacemakers were successfully treated with bilateral DBS STN therapy for refractory PD. To our knowledge, this is the first report on patients with cardiac pacemakers undergoing brain stimulator implantation.
Collapse
Affiliation(s)
- Patrick B Senatus
- Department of Neurological Surgery, Columbia College of Physicians and Surgeons, New York, New York 10032, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Kolbitsch C, Eisner W, Kleinsasser A, Biebl M, Fiegele T, Löckinger A, Lorenz IH, Mikuz G, Moser PL. External Cardiac Defibrillation Does Not Cause Acute Histopathological Changes Typical of Thermal Injuries in Pigs with In Situ Cerebral Stimulation Electrodes. Anesth Analg 2004; 98:458-460. [PMID: 14742387 DOI: 10.1213/01.ane.0000096192.33388.48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Parkinson's disease patients with long-term L-dopa syndrome may benefit from an implanted cerebral stimulation device. When advanced life support demands cardioversion or defibrillation in these patients, undesired effects of monophasic electroshocks might occur in brain tissue adjacent to the stimulation electrodes (e.g., thermal injury), but also in the stimulation device itself. Thus, in this animal study (n = 6 pigs), we investigated the effects of repeated defibrillation (2 x 200 J [n = 1] and 2 x 360 J [n = 5]) at the implantation site of cerebral stimulation electrodes and on stimulation device function. Repeated external cardiac defibrillation did not cause acute histopathologic changes typical of thermal injury to brain tissue adjacent to the cerebral stimulation electrodes. Functionality of the stimulator device after defibrillation, however, ranged from normal to total loss of function. Therefore, when defibrillation is performed, the greatest possible distance between the defibrillation site and the stimulator device implantation site should be considered. Subsequent testing of the stimulator device's function is mandatory. IMPLICATIONS Repeated cardiac defibrillation did not cause histopathologic changes typical of thermal injury at the implantation site of cerebral stimulation electrodes. The function of the stimulator device after defibrillation, however, ranged from normal to total loss of function.
Collapse
Affiliation(s)
- Christian Kolbitsch
- Departments of *Anaesthesia and Intensive Care Medicine, †Neurosurgery, ‡Vascular Surgery, and §Pathology, University of Innsbruck, Austria
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Kellinghaus C, Loddenkemper T, Möddel G, Tergau F, Lüders J, Lüdemann P, Nair DR, Lüders HO. [Electric brain stimulation for epilepsy therapy]. DER NERVENARZT 2003; 74:664-76. [PMID: 12904868 DOI: 10.1007/s00115-003-1541-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Attempts to control epileptic seizures by electrical brain stimulation have been performed for 50 years. Many different stimulation targets and methods have been investigated. Vagal nerve stimulation (VNS) is now approved for the treatment of refractory epilepsies by several governmental authorities in Europe and North America. However, it is mainly used as a palliative method when patients do not respond to medical treatment and epilepsy surgery is not possible. Numerous studies of the effect of deep brain stimulation (DBS) on epileptic seizures have been performed and almost invariably report remarkable success. However, a limited number of controlled studies failed to show a significant effect. Repetitive transcranial magnetic stimulation (rTMS) also was effective in open studies, and controlled studies are now being carried out. In addition, several uncontrolled reports describe successful treatment of refractory status epilepticus with electroconvulsive therapy (ECT). In summary, with the targets and stimulation parameters investigated so far, the effects of electrical brain stimulation on seizure frequency have been moderate at best. In the animal laboratory, we are now testing high-intensity, low-frequency stimulation of white matter tracts directly connected to the epileptogenic zone (e.g., fornix, corpus callosum) as a new methodology to increase the efficacy of DBS ("overdrive method").
Collapse
Affiliation(s)
- C Kellinghaus
- Department of Neurology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Rosenow JM, Tarkin H, Zias E, Sorbera C, Mogilner A. Simultaneous use of bilateral subthalamic nucleus stimulators and an implantable cardiac defibrillator. Case report. J Neurosurg 2003; 99:167-9. [PMID: 12854761 DOI: 10.3171/jns.2003.99.1.0167] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bilateral electrical stimulation of the subthalamic nucleus is being used with increasing frequency as a treatment for severe Parkinson disease (PD). Implantable cardiac defibrillators improve survival in certain high-risk patients with coronary artery disease and ventricular arrhythmias. Because of concern about possible interaction between these devices, deep brain stimulation (DBS) systems are routinely disconnected before defibrillators are implanted in patients with PD and arrhythmia. The authors report on a patient with bilateral subthalamic stimulators who underwent successful placement of an implantable defibrillator. Testing of the devices over a wide range of settings revealed no interaction. The patient subsequently underwent multiple episodes of cardioversion when the ventricular lead became dislodged. There was no evidence of adverse neurological effects, and interrogation of the DBS devices after cardioversion revealed no changes in stimulus parameters. The outcome in this case indicates that DBS systems may be safely retained in selected patients who require implantable cardiac defibrillators.
Collapse
Affiliation(s)
- Joshua M Rosenow
- Department of Neurosurgery, New York Medical College, Valhalla, New York 10595, USA
| | | | | | | | | |
Collapse
|
34
|
Sharan A, Rezai AR, Nyenhuis JA, Hrdlicka G, Tkach J, Baker K, Turbay M, Rugieri P, Phillips M, Shellock FG. MR safety in patients with implanted deep brain stimulation systems (DBS). ACTA NEUROCHIRURGICA SUPPLEMENTS 2003; 87:141-5. [PMID: 14518542 DOI: 10.1007/978-3-7091-6081-7_30] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION While it is desirable to perform MRI examinations in patients with deep brain stimulators (DBS), a major safety concern exists regarding the potential for excessive heating secondary to magnetically induced electrical currents. This study was designed to determine the safety of MRI and DBS. METHODS Standard configurations of DBS systems were tested. In vitro testing was performed using a 1.5-Tesla MR system, a gel-filled phantom, and the body and head RF coils with varying levels of RF energy (SAR). A fluoroptic thermometry system was used to record temperatures. RESULTS Using the 1.5-T MRI and body RF transmit coil, the temperature changes ranged from 2.5 to 25.3 degrees C. Using the 1.5-T MRI and head RF transmit coil, the temperature changes ranged from 2.3 to 7.1 degrees C. CONCLUSIONS Excessive heating does occur with certain MR imaging conditions. Under certain conditions determined in this study, patients with DBS may safely undergo anatomical MR imaging. In the future, standardized testing and more comprehensive studies will be needed to ensure the MR safety of neurostimulation systems.
Collapse
Affiliation(s)
- A Sharan
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Loddenkemper T, Pan A, Neme S, Baker KB, Rezai AR, Dinner DS, Montgomery EB, Lüders HO. Deep brain stimulation in epilepsy. J Clin Neurophysiol 2001; 18:514-32. [PMID: 11779965 DOI: 10.1097/00004691-200111000-00002] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Since the pioneering studies of Cooper et al. to influence epilepsy by cerebellar stimulation, numerous attempts have been made to reduce seizure frequency by stimulation of deep brain structures. Evidence from experimental animal studies suggests the existence of a nigral control of the epilepsy system. It is hypothesized that the dorsal midbrain anticonvulsant zone in the superior colliculi is under inhibitory control of efferents from the substantia nigra pars reticulata. Inhibition of the subthalamic nucleus (STN) could release the inhibitory effect of the substantia nigra pars reticulata on the dorsal midbrain anticonvulsant zone and thus activate the latter, raising the seizure threshold. Modulation of the seizure threshold by stimulation of deep brain structures-in particular, of the STN-is a promising future treatment option for patients with pharmacologically intractable epilepsy. Experimental studies supporting the existence of the nigral control of epilepsy system and preliminary results of STN stimulation in animals and humans are reviewed, and alternative mechanisms of seizure suppression by STN stimulation are discussed.
Collapse
Affiliation(s)
- T Loddenkemper
- Department of Neurology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
| | | | | | | | | | | | | | | |
Collapse
|