Technical analysis of dual channel pulse generators used in deep brain stimulation; a safety evaluation

BACKGROUNDDeep brain stimulation (DBS) is a powerful surgical option for drug-resistant movement disorders; however, electromagnetic interference (EMI) from external sources poses a potential risk for implanted electronics.OBSERVATIONSA 61-year-old woman with Parkinson’s disease originally had two implantable pulse generators (IPGs) for bilateral subthalamic DBS, which were then replaced with one dual-channel IPG routed in a loop. After the replacement surgery, with the same DBS programming as before the IPG replacement (bipolar setting for right, unipolar setting for left), the patient began to complain of transient paroxysmal diplopia. After multiple attempts to adjust the stimulation parameters, the diplopia was resolved by changing the left unipolar setting to a bipolar setting. At the authors’ institution, before the present case, four other patients had undergone IPG replacement with loop routing. None of these previous patients complained of diplopia; however, two of the four presented with diplopia in an experimental unipolar setting.LESSONSClinicians should be aware that loop-routed circuits may generate distortion of the stimulus field in DBS, even in the absence of external EMI sources.

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Effects of magnetic resonance imaging in patients with implanted deep brain stimulation systems

Journal of Neurosurgery ◽

10.3171/2010.1.jns09951 ◽

2010 ◽

Vol 113 (6) ◽

pp. 1242-1245 ◽

Cited By ~ 23

Author(s):

Valerie Fraix ◽

Stephan Chabardes ◽

Alexandre Krainik ◽

Eric Seigneuret ◽

Sylvie Grand ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Mr Imaging ◽

Brain Stimulation ◽

Reed Switch ◽

Pulse Generators ◽

Dual Channel ◽

Before And After ◽

Clinical Consequences ◽

Safety Guidelines ◽

Deep Brain

Object The aim of this study was to study the effects of MR imaging on the electrical settings of deep brain stimulation (DBS) systems and their clinical consequences. Methods The authors studied the effects of 1.5-T MR imaging on the electrical settings of implanted DBS systems, including 1 or more monopolar or quadripolar leads, extension leads, and single- or dual-channel implantable pulse generators (IPGs). The IPG was switched off during the procedure and the voltage was set to 0. The impedances were checked before and after MR imaging. Results Five hundred seventy patients were treated with DBS for movement disorders and underwent brain MR imaging after lead implantation and before IPG implantation. None of the patients experienced any adverse events. Thirty-one of these patients underwent 61 additional MR imaging sessions after the entire DBS system had been implanted. The authors report neither local cutaneous nor neurological disorders during or after the MR imaging session. No change in the IPG settings occurred when the magnet reed switch function remained disabled during the procedure. Conclusions This study demonstrates that 1.5-T MR imaging can be performed safely with continuous monitoring in patients with a DBS system. The ability to disable the magnet reed switch function of the IPG prevents any change in the electrical settings and thus any side effects. The increasing number of DBS indications and the widespread use of MR imaging indicates the need for defining safety guidelines for the use of MR imaging in patients with implanted neurostimulators.

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Deep brain stimulation lead-contact heating during 3T MRI: single- versus dual-channel pulse generator configurations

International Journal of Neuroscience ◽

10.3109/00207454.2013.840303 ◽

2013 ◽

Vol 124 (3) ◽

pp. 166-174 ◽

Cited By ~ 5

Author(s):

Jules M. Nazzaro ◽

Joshua A. Klemp ◽

William M. Brooks ◽

Galen Cook-Wiens ◽

Matthew S. Mayo ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Pulse Generator ◽

3T Mri ◽

Dual Channel ◽

Contact Heating ◽

Single Versus ◽

Deep Brain

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Surgical Replacement of Implantable Pulse Generators in Deep Brain Stimulation: Adverse Events and Risk Factors in a Multicenter Cohort

Stereotactic and Functional Neurosurgery ◽

10.1159/000447521 ◽

2016 ◽

Vol 94 (4) ◽

pp. 235-239 ◽

Cited By ~ 11

Author(s):

Anders Fytagoridis ◽

Tomas Heard ◽

Jennifer Samuelsson ◽

Peter Zsigmond ◽

Elena Jiltsova ◽

...

Keyword(s):

Risk Factors ◽

Deep Brain Stimulation ◽

Adverse Events ◽

Brain Stimulation ◽

Pulse Generators ◽

Multicenter Cohort ◽

Deep Brain

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Letter: Evaluation and Surgical Treatment of Functional Neurosurgery Patients With Implanted Deep Brain Stimulation and Vagus Nerve Stimulation Pulse Generators During the COVID-19 Pandemic

Neurosurgery ◽

10.1093/neuros/nyaa185 ◽

2020 ◽

Vol 87 (2) ◽

pp. E222-E226 ◽

Cited By ~ 4

Author(s):

Robert E Gross ◽

Cathrin M Buetefisch ◽

Svjetlana Miocinovic ◽

Katie L Bullinger ◽

Michael S Okun ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Surgical Treatment ◽

Vagus Nerve ◽

Brain Stimulation ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Functional Neurosurgery ◽

Pulse Generators ◽

Stimulation Pulse ◽

Deep Brain

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Characterization of the stimulus waveforms generated by implantable pulse generators for deep brain stimulation

Clinical Neurophysiology ◽

10.1016/j.clinph.2018.01.015 ◽

2018 ◽

Vol 129 (4) ◽

pp. 731-742 ◽

Cited By ~ 16

Author(s):

Scott F. Lempka ◽

Bryan Howell ◽

Kabilar Gunalan ◽

Andre G. Machado ◽

Cameron C. McIntyre

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Pulse Generators ◽

Deep Brain

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Stability of symptom control after replacement of impulse generators for deep brain stimulation

Journal of Neurosurgery ◽

10.3171/2009.1.jns081352 ◽

2009 ◽

Vol 110 (6) ◽

pp. 1274-1277 ◽

Cited By ~ 21

Author(s):

Niels Allert ◽

Holger Kirsch ◽

Waldemar Weirich ◽

Hans Karbe

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Single Channel ◽

Short Circuit ◽

Symptom Control ◽

Technical Problems ◽

Dual Channel ◽

Stimulation Parameters ◽

The Stability ◽

Deep Brain

Object Impulse generators (IPGs) for deep brain stimulation (DBS) need to be replaced when their internal batteries fail or when technical problems occur. New IPGs are routinely programmed with the previous stimulation parameters. In this study, the authors evaluate the stability of symptom control after such IPG replacements. Methods The authors retrospectively analyzed the outcome of 56 IPG replacements in 42 patients with various movement disorders treated using DBS. Results Stable symptom control was found in 65% of single-channel IPG replacements and 53% of dual-channel IPG replacements. Worsening of symptoms resulted primarily from changes in stimulation effects requiring reprogramming of stimulation parameters (17% of dual-channel IPG and 25% of single-channel IPG). In 14% of dualchannel IPG replacements, instability resulted from erroneous extension adjustment with change in laterality. A new short circuit of active with previously inactive contacts of the quadripolar stimulation lead resulted in a worsening of symptoms in 4% of replacements. Conclusions Replacement of the IPG requires careful follow-up of patients with DBS to ensure stable symptom control.

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