scholarly journals Electrocardiogram Artifacts Caused by Deep Brain Stimulation

2004 ◽  
Vol 31 (3) ◽  
pp. 343-346 ◽  
Author(s):  
Constantine Constantoyannis ◽  
Brett Heilbron
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Electrode Position ◽  
The Status ◽  
Common Electrode ◽  
The Common ◽  
Bipolar Patients ◽  
Ecg Artifacts ◽  
Ecg Interpretation ◽  
Deep Brain

Background:Deep brain stimulation (DBS) is increasingly used to treat a variety of neurological conditions (e.g. movement disorders and chronic pain). This prospective study was designed to detect electrocardiogram (ECG) artifacts induced by deep brain stimulation and to investigate which factors (patient disease, electrode position within the brain or type of stimulation) produced these artifacts.Methods:Twelve patients (four women, eight men) with deep brain stimulators were enrolled in the study. Patients were selected to represent the common indications for DBS (Parkinson's disease, tremor, dystonia), the common electrode locations (pallidum, thalamus, subthalamic nucleus) and the two types of stimulation (monopolar, bipolar). Patients had one ECG with the DBS turned 'on'and another with the DBS turned 'off'. The ECGs were then randomized and read by a cardiologist blinded to the status of the patient and DBS and artifacts were noted to be either present or absent.Results:The six patients using monopolar stimulation all had artifacts on their electrocardiograms. These artifacts were severe enough to interfere with ECG interpretation. There were no artifacts detected in the six patients using bipolar stimulation. Electrode location and patient disease appeared to have no effect on ECG artifact.Conclusion:Deep brain stimulation can cause ECG artifacts when monopolar settings are used. These artifacts are not present with bipolar settings or when the DBS is turned 'off'. Knowledge of these potential ECG artifacts and how to avoid them is essential to facilitate accurate ECG interpretation.

Symptomatic Cystic Lesion Following Deep Brain Stimulation Surgery

2020 ◽  
pp. 37-40
Author(s):  
Vibhash D. Sharma ◽  
Shilpa Chitnis
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Rare Complication ◽  
Cyst Formation ◽  
Management Options ◽  
Unexplained Symptoms ◽  
The Common ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Deep brain stimulation therapy is an effective therapy for selected patients with movement disorders. The procedure is relatively safe, but complications related to the surgical procedure or implanted hardware can occur. The common complications include hemorrhage, infarct, infection, and confusion. Noninfectious cyst formation around the DBS lead is a rare but potential complication of this procedure, which can occur several weeks to months after DBS lead implantation. This chapter describes a case of noninfectious cyst formation at the tip of DBS lead in a patient with essential tremor. Clinical presentation, role of imaging, and the management options for this rare complication are discussed. This case also illustrates the importance of post-DBS imaging in suspected cases with new or unexplained symptoms.

scholarly journals An Assessment of Current Brain Targets for Deep Brain Stimulation Surgery With Susceptibility-Weighted Imaging at 7 Tesla

Neurosurgery ◽  
2010 ◽  
Vol 67 (6) ◽  
pp. 1745-1756 ◽  
Author(s):  
Aviva Abosch ◽  
Essa Yacoub ◽  
Kamil Ugurbil ◽  
Noam Harel
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Image Resolution ◽  
7 Tesla ◽  
Patient Specific ◽  
Susceptibility Weighted Imaging ◽  
Target Area ◽  
Electrode Position ◽  
Microelectrode Recording ◽  
Deep Brain

Abstract BACKGROUND: Deep brain stimulation (DBS) surgery is used for treating movement disorders, including Parkinson disease, essential tremor, and dystonia. Successful DBS surgery is critically dependent on precise placement of DBS electrodes into target structures. Frequently, DBS surgery relies on normalized atlas-derived diagrams that are superimposed on patient brain magnetic resonance imaging (MRI) scans, followed by microelectrode recording and macrostimulation to refine the ultimate electrode position. Microelectrode recording carries a risk of hemorrhage and requires active patient participation during surgery. OBJECTIVE: To enhance anatomic imaging for DBS surgery using high-field MRI with the ultimate goal of improving the accuracy of anatomic target selection. METHODS: Using a 7-T MRI scanner combined with an array of acquisition schemes using multiple image contrasts, we obtained high-resolution images of human deep nuclei in healthy subjects. RESULTS: Superior image resolution and contrast obtained at 7 T in vivo using susceptibility-weighted imaging dramatically improved anatomic delineation of DBS targets and allowed the identification of internal architecture within these targets. A patient-specific, 3-dimensional model of each target area was generated on the basis of the acquired images. CONCLUSION: Technical developments in MRI at 7 T have yielded improved anatomic resolution of deep brain structures, thereby holding the promise of improving anatomic-based targeting for DBS surgery. Future study is needed to validate this technique in improving the accuracy of targeting in DBS surgery.

scholarly journals Intraoperative MRI for optimizing electrode placement for deep brain stimulation of the subthalamic nucleus in Parkinson disease

2016 ◽  
Vol 124 (1) ◽  
pp. 62-69 ◽  
Author(s):  
Zhiqiang Cui ◽  
Longsheng Pan ◽  
Huifang Song ◽  
Xin Xu ◽  
Bainan Xu ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Intraoperative Mri ◽  
Electrode Position ◽  
Brain Shift ◽  
Anatomical Position ◽  
Lead Placement ◽  
Deep Brain

OBJECT The degree of clinical improvement achieved by deep brain stimulation (DBS) is largely dependent on the accuracy of lead placement. This study reports on the evaluation of intraoperative MRI (iMRI) for adjusting deviated electrodes to the accurate anatomical position during DBS surgery and acute intracranial changes. METHODS Two hundred and six DBS electrodes were implanted in the subthalamic nucleus (STN) in 110 patients with Parkinson disease. All patients underwent iMRI after implantation to define the accuracy of lead placement. Fifty-six DBS electrode positions in 35 patients deviated from the center of the STN, according to the result of the initial postplacement iMRI scans. Thus, we adjusted the electrode positions for placement in the center of the STN and verified this by means of second or third iMRI scans. Recording was performed in adjusted parameters in the x-, y-, and z-axes. RESULTS Fifty-six (27%) of 206 DBS electrodes were adjusted as guided by iMRI. Electrode position was adjusted on the basis of iMRI 62 times. The sum of target coordinate adjustment was −0.5 mm in the x-axis, −4 mm in the y-axis, and 15.5 mm in the z-axis; the total of distance adjustment was 74.5 mm in the x-axis, 88 mm in the y-axis, and 42.5 mm in the z-axis. After adjustment with the help of iMRI, all electrodes were located in the center of the STN. Intraoperative MRI revealed 2 intraparenchymal hemorrhages in 2 patients, brain shift in all patients, and leads penetrating the lateral ventricle in 3 patients. CONCLUSIONS The iMRI technique can guide surgeons as they adjust deviated electrodes to improve the accuracy of implanting the electrodes into the correct anatomical position. The iMRI technique can also immediately demonstrate acute changes such as hemorrhage and brain shift during DBS surgery.

scholarly journals Factors Influencing Electrode Position and Bending of the Proximal Lead in Deep Brain Stimulation for Movement Disorders

2020 ◽  
Vol 98 (5) ◽  
pp. 300-312
Author(s):  
Jacob Niederer ◽  
Rémi Patriat ◽  
Oren Rosenberg ◽  
Tara Palnitkar ◽  
David Darrow ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Electrode Position ◽  
Factors Influencing ◽  
Deep Brain

Deep Brain Stimulation for Neuropathic Cephalalgia

Cephalalgia ◽  
2006 ◽  
Vol 26 (5) ◽  
pp. 561-567 ◽  
Author(s):  
AL Green ◽  
SLF Owen ◽  
P Davies ◽  
L Moir ◽  
TZ Aziz
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Electrode Position ◽  
Pain Scores ◽  
Related Quality ◽  
Wide Variability ◽  
Health Related ◽  
Ventroposteromedial Nucleus ◽  
Deep Brain

The aim of this study was to determine the efficacy of deep brain stimulation (DBS) in the treatment of various types of intractable head and facial pains. Seven patients underwent the insertion of DBS electrodes into the periventricular/periaqueductal grey region and/or the ventroposteromedial nucleus of the thalamus. We have shown statistically significant improvement in pain scores (visual analogue and McGill's) as well as health-related quality of life (SF-36v2) following surgery. There is wide variability in patient outcomes but, overall, DBS can be an effective treatment. Our results are compared with the published literature and electrode position for effective analgesia is discussed.

Deep Brain Stimulation Electrophysiology

2016 ◽  
pp. 730-744
Author(s):  
Bryan T. Klassen
Keyword(s):  
Deep Brain Stimulation ◽  
Side Effects ◽  
Brain Stimulation ◽  
Electrical Current ◽  
Outpatient Setting ◽  
Electrode Position ◽  
Test Stimulation ◽  
High Impedance ◽  
Maximum Benefit ◽  
Deep Brain

Deep brain stimulation (DBS) is a therapy for medically refractory movement disorders, and the indications for DBS are likely to expand to other neurological and psychiatric diseases. DBS involves the delivery of electrical current to specific brain targets using a permanently implantable stimulating electrode that is surgically placed under stereotactic guidance. The efficacy and side effects of DBS are directly related to the position of the implantable stimulating electrode. While current imaging modalities help define an initial trajectory to the target region, most centers also rely on neurophysiological confirmation of electrode position. High-impedance microelectrode recording can define both spontaneous and stimulus-evoked firing patterns of the cells along the lead’s trajectory. By comparing these findings to those expected, one can determine whether the electrode’s final position is as intended. The effects encountered during intraoperative test stimulation delivered through the implanted electrode further define the accuracy of positioning. Stimulation parameters can be refined in the outpatient setting in order to provide the maximum benefit and least side effects.

Postoperative Curving and Upward Displacement of Deep Brain Stimulation Electrodes Caused by Brain Shift

Neurosurgery ◽  
2010 ◽  
Vol 67 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Pepijn van den Munckhof ◽  
M. Fiorella Contarino ◽  
Lo J. Bour ◽  
Johannes D. Speelman ◽  
Rob M. A. de Bie ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Frontal Cortex ◽  
Brain Stimulation ◽  
Original Position ◽  
Electrode Position ◽  
Electrode Displacement ◽  
Upward Displacement ◽  
The Brain ◽  
Deep Brain

Abstract BACKGROUND Accurate electrode position is important for the efficacy of deep brain stimulation (DBS). Several reports revealed errors during stereotactic surgery due to cerebrospinal fluid (CSF) loss and subdural air invasion. Because subdural air resolves in the weeks after surgery and the brain returns to its original position, DBS electrodes may become displaced postoperatively. OBJECTIVE To quantitatively assess postoperative DBS electrode displacement in relation to subdural air invasion. METHODS We retrospectively analyzed 14 patients with advanced Parkinson disease and subthalamic nucleus DBS electrodes that underwent immediate postoperative frame-based stereotactic computer tomography (CT) and repeated CT after longer follow-up. We performed volumetric measurements of postoperative subdural air collections on both sides of the brain and determined stereotactic coordinates of the deepest DBS contact on the direct postoperative and follow-up CT. RESULTS Subdural air collections measured on average 17 ± 24 cm3. Consequently, the frontal cortex shifted posteriorly. On follow-up imaging after 16 ± 8 months, air collections had resolved and the frontal cortex had returned to its original position, causing anterior curving of the electrodes. The electrodes moved on average 3.3 ± 2.5 mm upward along the trajectory. This displacement significantly correlated with the amount of postoperative subdural air. CONCLUSION Considerable displacement of DBS electrodes may occur in the weeks following surgery, especially in cases with large postoperative subdural air volumes. Postoperative documentation of electrode localization should therefore be repeated after longer follow-up.

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