Interaction between cardiac pacemakers and deep brain stimulation pulse generators: Technical considerations

Basal Ganglia ◽  
2016 ◽  
Vol 6 (1) ◽  
pp. 19-22 ◽  
Author(s):  
Mayur Sharma ◽  
Darla Talbott ◽  
Milind Deogaonkar
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Cardiac Pacemakers ◽  
Pulse Generators ◽  
Stimulation Pulse ◽  
Technical Considerations ◽  
Deep Brain

Deep Brain Stimulation in Patients With Concomitant Cardiac Pacemakers: A Case Series

2019 ◽  
Vol 17 (6) ◽  
pp. 549-553 ◽  
Author(s):  
Tomas Heard ◽  
Terry Coyne ◽  
Peter Silburn
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Case Series ◽  
Cardiac Pacemaker ◽  
Cardiac Pacemakers ◽  
Psychiatric Conditions ◽  
Clinically Significant ◽  
Significant Interference ◽  
Technical Considerations ◽  
Deep Brain

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.

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

2016 ◽  
Vol 94 (4) ◽  
pp. 235-239 ◽  
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

Diplopia associated with loop routing in deep brain stimulation: illustrative case

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Yasushi Miyagi ◽  
Eiichirou Urasaki
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Electromagnetic Interference ◽  
Illustrative Case ◽  
Pulse Generators ◽  
Replacement Surgery ◽  
Dual Channel ◽  
Stimulation Parameters ◽  
External Sources ◽  
Deep Brain

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.

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

2018 ◽  
Vol 129 (4) ◽  
pp. 731-742 ◽  
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

Long-term deep brain stimulation in elderly patients with cardiac pacemakers

2005 ◽  
Vol 102 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Hans-Holger Capelle ◽  
Richard K. Simpson ◽  
Martin Kronenbuerger ◽  
Jochen Michaelsen ◽  
Volker Tronnier ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Elderly Patients ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Cardiac Pacemakers ◽  
Content Type ◽  
Two Systems ◽  
Fine Print ◽  
Deep Brain ◽  
Stimulation Of

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.

Single-Center Complication Analysis Associated with Surgical Replacement of Implantable Pulse Generators in Deep Brain Stimulation

2019 ◽  
Vol 97 (2) ◽  
pp. 101-105 ◽  
Author(s):  
Yislenz Narváez-Martínez ◽  
Pedro Roldán Ramos ◽  
John Alexander Hoyos ◽  
Diego Culebras ◽  
Yaroslau Compta ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Single Center ◽  
Pulse Generators ◽  
Deep Brain

Management of Pulse Generators in a Breast Cancer Patient with in Situ Subthalamic Nucleus Deep Brain Stimulation

2019 ◽  
Vol 80 (03) ◽  
pp. 223-227 ◽  
Author(s):  
Byung-chul Son ◽  
Joong-Seok Kim ◽  
Woo-Chan Park ◽  
Hak-cheol Ko
Keyword(s):  
Breast Cancer ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Anterior Chest Wall ◽  
Open Circuit ◽  
Imaging Studies ◽  
Pulse Generators ◽  
Stn Dbs ◽  
Deep Brain

Although deep brain stimulation (DBS) has been used for > 25 years in the treatment of movement disorders, no report has been published on the management of DBS pulse generators implanted in the anterior chest in patients with breast cancer who require mastectomy, radiotherapy, and future imaging studies.We describe a 62-year-old female patient with advanced Parkinson's disease (PD) who was dependent on bilateral subthalamic nucleus (STN) DBS. She was diagnosed with cancer in her left breast. To avoid difficulties in imaging studies, surgery, and radiotherapy related to the breast cancer, bilateral pulse generators for STN DBS previously implanted in the anterior chest wall were repositioned to the anterior abdominal wall with replacement of long extension cables. During mastectomy and the relocation of the pulse generators, we were not aware of the risks of an open circuit and neuroleptic malignant-like syndrome due to our limited knowledge about how to manage DBS hardware.Coincident breast cancer and the need for STN DBS is underreported. Considering the uncertainties in the management of pulse generators and the incidence of breast cancer, guidelines for handling DBS hardware in the setting of cancer are needed. More careful attention should be paid to performing magnetic resonance imaging in DBS-dependent patients with chronic PD.

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