scholarly journals Neurological Worsening After Implantable Pulse Generator Replacement

2019 ◽  
Vol 46 (5) ◽  
pp. 527-532
Author(s):  
Niraj Kumar ◽  
Aditya Murgai ◽  
Mandar Jog
Keyword(s):  
Pulse Generator ◽  
Retrospective Chart Review ◽  
Electrical Energy ◽  
Therapeutic Interventions ◽  
Pulse Generators ◽  
Dual Channel ◽  
Stimulation Parameters ◽  
A Minor ◽  
Electrophysiological Correlate ◽  
Deep Brain

ABSTRACT:Background:Most of the implantable pulse generators (IPGs) in deep brain stimulation (DBS) used to date are non-rechargeable requiring regular replacements. IPG replacement is a minor surgical procedure, but adverse events including neurological worsening have been reported. In this study, we determine the possibility of neurological worsening after IPG replacement in Parkinson’s disease (PD) cases on chronic DBS therapy (CDT) and its electrophysiological basis along with the therapeutic interventions used to alleviate them.Methods:This study is a retrospective chart review of PD cases on CDT followed at London Movement Disorders Centre from January 2010 to December 2016. Included cases were those who underwent one or more IPG replacement.Results:A total of 45 PD cases on CDT underwent 62 IPG replacements involving 121 channels. Neurological worsening was observed in 16 (35.5%) cases following 17 (27.4%) IPG replacements, all following dual-channel IPG replacements. Tremor (41.2%), speech (35.3%), and gait (23.5%) worsened most commonly. Deviation from the pre-replacement parameters including voltage and impedance resulting in change in total electrical energy delivered (TEED) was the most common electrophysiological correlate, observed in 82.4% (14/17) IPGs having neurological worsening. This included switched laterality in a dual-channel IPG. Neurological worsening in the remaining 17.6% cases was hardware-related.Conclusion:Neurological worsening followed 27.4% of IPG replacements in PD cases on CDT with approximately 82.4% of these being avoidable by carefully monitoring stimulation parameters to match pre-replacement TEED values.

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.

Precise control of stimulation parameters in low impedance conditions

1965 ◽  
Vol 20 (2) ◽  
pp. 334-338 ◽  
Author(s):  
L. W. Mills ◽  
J. E. Swett
Keyword(s):  
Operational Amplifier ◽  
Pulse Generator ◽  
Impedance Matching ◽  
Stimulus Pulse ◽  
Precise Control ◽  
Dual Channel ◽  
Stimulation Parameters ◽  
Impedance Conditions ◽  
Isolation Transformer ◽  
Deep Brain

A system is described for accurate control of stimulation parameters in conditions where impedances between 100 and 30,000 ohms are encountered across the secondary of a stimulus isolation transformer. The dual-channel stimulator is constructed mainly from Tektronix 160 series pulse and waveform generators. The stimulator was designed primarily for evoked potential studies in the nervous system with peripheral nerve stimulation but will operate equally well with concentric or needle electrodes in deep brain structure, providing that total electrode-tissue impedances are kept within the stipulated limits. The unique feature of the stimulator is embodied in the operational amplifier interposed between the Tektronix stimulus pulse generator and the primary of the isolation transformer. This system is designed to read directly in stimulus intensities relative to any stipulated physiological threshold. Absolute stimulus voltages may be continuously monitored to ± 3% accuracy. The impedance matching characteristics of the described system will permit effective stimulation of excitable tissues while maintaining stimulus control by the operational amplifier settings within ± 1%. The large range of pulse durations, stimulus intensities, and the use of more than one type of stimulus waveform, have been sacrificed in favor of maintaining rigid control over pulse waveforms and amplitudes with passage of large stimulating currents at low intensities. This system comes close to achieving those qualities embodied in the ideal constant voltage stimulator. physiological stimulation; biological stimulator; low impedance stimulation; Tektronix-adapted units for biological stimulation; isolated stimulator; nerve stimulator; physiological threshold stimulator Submitted on July 10, 1964

Bowstringing as a Complication of Deep Brain Stimulation

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. E1205-E2010 ◽  
Author(s):  
Christopher Janson ◽  
Robert Maxwell ◽  
Akshay A. Gupte ◽  
Aviva Abosch
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Pulse Generator ◽  
Single Channel ◽  
Case Series ◽  
Deep Brain Stimulator ◽  
Pulse Generators ◽  
Dual Channel ◽  
Operative Revision ◽  
Deep Brain

Abstract OBJECTIVE This retrospective case series describes bowstringing as a complication of deep brain stimulator implantation for Parkinson's disease, defined as abnormal tethering of leads between the pulse generator and stimulating electrode, associated with contracture of the patient's neck over the extension cable. There are no previous reports of this specific complication, which presumably has been more broadly classified under hardware-related complications. CLINICAL PRESENTATION Bowstringing may result in discomfort, restriction of movements, and/or equipment malfunction. Patients were identified by postoperative surveillance in clinic and by review of our database of Parkinson's disease patients who had undergone subthalamic nucleus deep brain stimulator placement. The incidence of this complication was 2.6% (6/228) in our overall clinic population, composed of 0% (0/181) of patients who received a Soletra pulse generator and 12.7% (6/47) of patients who received a Kinetra pulse generator. INTERVENTION The proportion of patients with bowstringing requiring operative revision was 83% (5/6), with 60% (3/5) patients undergoing conversion to single-channel pulse generators and 40% (2/5) undergoing revision of the original dual-channel pulse generator. CONCLUSION Factors associated with bowstringing include the use of dual-channel pulse generators and scar lysis complicated by seroma or infection. The mean time from implantation to bowstringing was 8.6 months with a range of 0.5 to 22 months. Bowstringing is a rare but potentially serious complication, and further study is needed to accurately predict and avoid this problem.

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

2013 ◽  
Vol 124 (3) ◽  
pp. 166-174 ◽  
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

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

2009 ◽  
Vol 110 (6) ◽  
pp. 1274-1277 ◽  
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.

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

2010 ◽  
Vol 113 (6) ◽  
pp. 1242-1245 ◽  
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.

scholarly journals Implantable Pulse Generators for Deep Brain Stimulation: Challenges, Complications, and Strategies for Practicality and Longevity

2021 ◽  
Vol 15 ◽  
Author(s):  
Can Sarica ◽  
Christian Iorio-Morin ◽  
David H. Aguirre-Padilla ◽  
Ahmed Najjar ◽  
Michelle Paff ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Near Infrared ◽  
Electrode Materials ◽  
Pulse Generator ◽  
Field Potential ◽  
Invasive Treatment ◽  
Pulse Generators ◽  
Hardware Complications ◽  
Deep Brain

Deep brain stimulation (DBS) represents an important treatment modality for movement disorders and other circuitopathies. Despite their miniaturization and increasing sophistication, DBS systems share a common set of components of which the implantable pulse generator (IPG) is the core power supply and programmable element. Here we provide an overview of key hardware and software specifications of commercially available IPG systems such as rechargeability, MRI compatibility, electrode configuration, pulse delivery, IPG case architecture, and local field potential sensing. We present evidence-based approaches to mitigate hardware complications, of which infection represents the most important factor. Strategies correlating positively with decreased complications include antibiotic impregnation and co-administration and other surgical considerations during IPG implantation such as the use of tack-up sutures and smaller profile devices.Strategies aimed at maximizing battery longevity include patient-related elements such as reliability of IPG recharging or consistency of nightly device shutoff, and device-specific such as parameter delivery, choice of lead configuration, implantation location, and careful selection of electrode materials to minimize impedance mismatch. Finally, experimental DBS systems such as ultrasound, magnetoelectric nanoparticles, and near-infrared that use extracorporeal powered neuromodulation strategies are described as potential future directions for minimally invasive treatment.

SELECTION OF THE DRIVE OF THE PULSE GENERATOR FOR WAVE DEFORMATION HARDENING

2020 ◽  
Author(s):  
Andrey Kirichek ◽  
Dmitriy Solovyev
Keyword(s):  
Strain Hardening ◽  
Pulse Generator ◽  
Surface Plastic Deformation ◽  
Surface Plastic ◽  
Impact Frequency ◽  
Metal Consumption ◽  
Pulse Generators ◽  
Energy Impact ◽  
Deformation Hardening ◽  
Selection Of

The article is devoted to the analysis of known structures of impact devices used in industry in order to obtain recommendations for their adaptation or when creating new structures for wave strain hardening by surface plastic deformation. The analysis was carried out on the used drive and on the main parameters of impact devices: impact energy, impact frequency, relative metal consumption and efficiency. The options are the best combinations of parameters for electric, pneumatic and hydraulic drives. Recommendations are given on the use of such devices, with appropriate adaptation, as pulse generators for wave strain hardening.

Reoperation for device infection and erosion following deep brain stimulation implantable pulse generator placement

2020 ◽  
Vol 133 (2) ◽  
pp. 403-410 ◽  
Author(s):  
Travis J. Atchley ◽  
Nicholas M. B. Laskay ◽  
Brandon A. Sherrod ◽  
A. K. M. Fazlur Rahman ◽  
Harrison C. Walker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Pulse Generator ◽  
Rank Test ◽  
Implantable Pulse Generator ◽  
Device Infection ◽  
Deep Brain

OBJECTIVEInfection and erosion following implantable pulse generator (IPG) placement are associated with morbidity and cost for patients with deep brain stimulation (DBS) systems. Here, the authors provide a detailed characterization of infection and erosion events in a large cohort that underwent DBS surgery for movement disorders.METHODSThe authors retrospectively reviewed consecutive IPG placements and replacements in patients who had undergone DBS surgery for movement disorders at the University of Alabama at Birmingham between 2013 and 2016. IPG procedures occurring before 2013 in these patients were also captured. Descriptive statistics, survival analyses, and logistic regression were performed using generalized linear mixed effects models to examine risk factors for the primary outcomes of interest: infection within 1 year or erosion within 2 years of IPG placement.RESULTSIn the study period, 384 patients underwent a total of 995 IPG procedures (46.4% were initial placements) and had a median follow-up of 2.9 years. Reoperation for infection occurred after 27 procedures (2.7%) in 21 patients (5.5%). No difference in the infection rate was observed for initial placement versus replacement (p = 0.838). Reoperation for erosion occurred after 16 procedures (1.6%) in 15 patients (3.9%). Median time to reoperation for infection and erosion was 51 days (IQR 24–129 days) and 149 days (IQR 112–285 days), respectively. Four patients with infection (19.0%) developed a second infection requiring a same-side reoperation, two of whom developed a third infection. Intraoperative vancomycin powder was used in 158 cases (15.9%) and did not decrease the infection risk (infected: 3.2% with vancomycin vs 2.6% without, p = 0.922, log-rank test). On logistic regression, a previous infection increased the risk for infection (OR 35.0, 95% CI 7.9–156.2, p < 0.0001) and a lower patient BMI was a risk factor for erosion (BMI ≤ 24 kg/m2: OR 3.1, 95% CI 1.1–8.6, p = 0.03).CONCLUSIONSIPG-related infection and erosion following DBS surgery are uncommon but clinically significant events. Their respective timelines and risk factors suggest different etiologies and thus different potential corrective procedures.

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