scholarly journals Pacemaker and Defibrillator Implantation and Programming in Patients with Deep Brain Stimulation

2019 ◽  
Vol 8 (2) ◽  
pp. 138-142 ◽  
Author(s):  
Mark Elliott ◽  
Sheikh Momin ◽  
Barnaby Fiddes ◽  
Fahad Farooqi ◽  
SM Afzal Sohaib
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Case Reports ◽  
Cardiac Pacemaker ◽  
Cardiac Device ◽  
Deep Brain Stimulator ◽  
Device Implantation ◽  
Cardiac Devices ◽  
Potential Interactions ◽  
Deep Brain

The need for cardiac device implantation in patients receiving deep brain stimulation (DBS) is increasing. Despite the theoretical risk of the two systems interacting, there are no clear guidelines for cardiologists carrying out cardiac device implantation in this population. We performed a review of the literature and describe 13 case reports in which patients have both DBS and a cardiac pacemaker or ICD implanted. Except for one early study, in which an ICD shock reset the deep brain stimulator, no significant interactions have been reported. We discuss the potential interactions between DBS and cardiac devices, and provide practical advice for implanting cardiologists. We conclude that, provided that specific precautions are taken, cardiac device implantation is likely to be safe in patients with DBS.

Deep Brain Stimulation Generator Failure due to External Defibrillation in a Patient with Essential Tremor

2020 ◽  
pp. 1-2
Author(s):  
Gregory Davis ◽  
Zachary Levine
Keyword(s):  
Cardiac Arrest ◽  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Case Reports ◽  
The Other ◽  
Deep Brain Stimulator ◽  
Rf Transmission ◽  
Deep Brain

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.

scholarly journals Technical nuances to minimize common complications of deep brain stimulation

2017 ◽  
Vol 42 (videosuppl2) ◽  
pp. V2
Author(s):  
Paul House
Keyword(s):  
Deep Brain Stimulation ◽  
Surgical Technique ◽  
Brain Stimulation ◽  
Deep Brain Stimulator ◽  
Link Type ◽  
Prospective Trials ◽  
Skin Erosion ◽  
Deep Brain

The implantation of deep brain stimulator electrodes is associated with infrequent complications. These complications are consistent across prospective trials and include infection, skin erosion, hemorrhage, and lead misplacement. Nuances of surgical technique can be used to minimize the risk of these commonly noted complications. Several of these technical nuances are highlighted in this video submission.The video can be found here: https://youtu.be/GL09W9p013g.

Database of MNI stereotactic coordinates for deep brain stimulation targets in neuropsychiatric disorders

2011 ◽  
Vol 26 (S2) ◽  
pp. 1149-1149
Author(s):  
U. Moser ◽  
M. Savli ◽  
R. Lanzenberger ◽  
S. Kasper
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Functional Neuroimaging ◽  
Case Reports ◽  
Three Dimensional ◽  
Compulsive Disorder ◽  
Neuroimaging Data ◽  
Specific Disorders ◽  
Image Position ◽  
Deep Brain

IntroductionDeep brain stimulation (DBS) is a promising therapy option for otherwise treatment-resistant neuropsychiatrie disorders, especially in obsessive-compulsive disorder (OCD), major depression (TRD) and Tourette's Syndrome (TS).ObjectiveThe brain coordinates of the DBS targets are mainly reported using measurements in original, unnormalized brains. In the neuroimaging community stereotactic data are mainly indicated in the standardized Montreal Neurological Institute (MNI) space, i.e. a three-dimensional proportional grid system.AimsImproved comparability between targets in DBS studies and molecular and functional neuroimaging data from PET, SPECT, MRI, fMRI, mostly published with stereotactic data.MethodsA comprehensive and systematic literature search for published DBS case reports or studies in TRD, OCD and TS was performed. We extracted the tip positions of electrode leads as provided in the publications or by the authors, and transferred individual coordinates to the standard brain in the MNI space.Results46 publications fulfilled the inclusion criteria. The main targets for the specific disorders and one or two examples of their calculated MNI coordinates are indicated in the table:[MNI coordinates of the main DBS targets]ConclusionsWe provide DBS data of neuropsychiatrie disorders in the MNI space, improving the comparability to molecular, functional and structural neuroimaging data.

scholarly journals Pallidotomy after chronic deep brain stimulation

2013 ◽  
Vol 35 (5) ◽  
pp. E5 ◽  
Author(s):  
Kristian J. Bulluss ◽  
Erlick A. Pereira ◽  
Carole Joint ◽  
Tipu Z. Aziz
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Full Time ◽  
Progressive Dementia ◽  
Deep Brain Stimulator ◽  
Beneficial Effects ◽  
Unilateral Pallidotomy ◽  
Deep Brain

Recent publications have demonstrated that deep brain stimulation for Parkinson's disease still exerts beneficial effects on tremor, rigidity, and bradykinesia for up to 10 years after implantation of the stimulator. However with the progression of Parkinson's disease, features such as cognitive decline or “freezing” become prominent, and the presence of an implanted and functioning deep brain stimulator can impose a profound burden of care on the clinical team and family. The authors describe their experience in treating 4 patients who underwent removal of the implanted device due to either progressive dementia requiring full-time nursing or due to infection, and who subsequently underwent a unilateral pallidotomy.

scholarly journals Impulse Control Disorders Following Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's Disease: Clinical Aspects

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Polyvios Demetriades ◽  
Hugh Rickards ◽  
Andrea Eugenio Cavanna
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Impulse Control ◽  
Case Reports ◽  
Impulse Control Disorders ◽  
Clinical Aspects ◽  
Dopaminergic Medication ◽  
Deep Brain

Parkinson's disease (PD) has been associated with the development of impulse control disorders (ICDs), possibly due to overstimulation of the mesolimbic system by dopaminergic medication. Preliminary reports have suggested that deep brain stimulation (DBS), a neurosurgical procedure offered to patients with treatment-resistant PD, affects ICD in a twofold way. Firstly, DBS allows a decrease in dopaminergic medication and hence causes an improvement in ICDs. Secondly, some studies have proposed that specific ICDs may develop after DBS. This paper addresses the effects of DBS on ICDs in patients with PD. A literature search identified four original studies examining a total of 182 patients for ICDs and nine case reports of 39 patients that underwent DBS and developed ICDs at some point. Data analysis from the original studies did not identify a significant difference in ICDs between patients receiving dopaminergic medication and patients on DBS, whilst the case reports showed that 56% of patients undergoing DBS had poor outcome with regards to ICDs. We discuss these ambivalent findings in the light of proposed pathogenetic mechanisms. Longitudinal, prospective studies with larger number of patients are required in order to fully understand the role of DBS on ICDs in patients with PD.

scholarly journals Neuropsychiatric Outcome of an Adolescent Who Received Deep Brain Stimulation for Tourette's Syndrome

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
S. J. Pullen ◽  
C. A. Wall ◽  
K. H. Lee ◽  
S. M. Stead ◽  
B. T. Klassen ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Adaptive Functioning ◽  
Case Reports ◽  
Tourette's Syndrome ◽  
Adolescent Male ◽  
Tourette’S Syndrome ◽  
Patient Reported ◽  
Deep Brain ◽  
Neuropsychiatric Outcome

This case study followed one adolescent patient who underwent bilateral deep brain stimulation of the centromedian parafascicular complex (CM-Pf) for debilitating, treatment refractory Tourette's syndrome for a period of 1.5 years. Neurocognitive testing showed no significant changes between baseline and follow-up assessments. Psychiatric assessment revealed positive outcomes in overall adaptive functioning and reduction in psychotropic medication load in this patient. Furthermore, despite significant baseline psychiatric comorbidity, this patient reported no suicidal ideation following electrode implantation. Deep brain stimulation is increasingly being used in children and adolescents. This case reports on the positive neurologic and neuropsychiatric outcome of an adolescent male with bilateral CM-Pf stimulation.

scholarly journals A Systematic Review of the Biological Processes Involved in Deep-Brain Stimulation for Parkinson's disease: A Focus on the Potential Disease-Modifying Effects

2021 ◽  
Vol 05 (02) ◽  
pp. 1-1
Author(s):  
Francesco Sciancalepore ◽  
◽  
Giulia Remoli ◽  
Leonardo Tariciotti ◽  
Giulia Sarti ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Early Stage ◽  
Case Reports ◽  
Biological Processes ◽  
Inclusion Criteria ◽  
Disease Modifying ◽  
Deep Brain

Deep-Brain Stimulation (DBS) is an important treatment option for the management of Parkinson’s disease (PD) and is a common symptomatic treatment. However, an increasing number of studies have examined the biological processes to assess if DBS can also modify the natural history of PD by acting on its pathophysiological mechanisms. Relevant literature published up to November 2020 was systematically searched on databases such as PubMed, ISI Web of Knowledge, Academic Search Index, and Science Citation Index. The following predefined inclusion criteria were applied to the full-text versions of the selected articles: i) recruiting and monitoring of PD subjects that were previously treated with DBS and ii) investigating the electrophysiological, biochemical, epigenetic, or neuroimaging effects of DBS. Studies focusing exclusively on motor and clinical changes were excluded. Reviews, case reports, studies on animal models, and computational studies were also not considered. Out of 2,960 records screened, 43 studies met the inclusion criteria. Only three studies described a potential disease-modifying effect of DBS. However, a wide heterogeneity was observed in the investigated biomarkers, and the design and methodological issues of several studies limited their ability to find potential disease-modifying features. Specifically, 60.4% of the trials followed-up subjects for no more than 1 year from the surgical intervention, and 67.4% observed patients with PD only once after DBS. Moreover, 64.2% of the studies enrolled late-stage PD patients. Most of the studies (88.4%) reported that DBS only had a symptomatic effect, with several of them showing some limitations in the study design and recruitment of patients. Further studies using shared biomarkers are encouraged to assess if and how DBS might affect the progression of PD. Based on the existing preclinical literature, prospective clinical trials examining the course of PD in early-stage patients are needed.

scholarly journals Deep brain stimulation for orthostatic tremor

2019 ◽  
Vol 10 (4) ◽  
pp. 324-332 ◽  
Author(s):  
Angela L. Hewitt ◽  
Bryan T. Klassen ◽  
Kendall H. Lee ◽  
Jamie J. Van Gompel ◽  
Anhar Hassan
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Case Reports ◽  
Weight Bearing ◽  
Clinical Electrophysiology ◽  
Onset Latency ◽  
Meaningful Improvement ◽  
Standing Time ◽  
Orthostatic Tremor ◽  
Deep Brain

BackgroundOrthostatic tremor (OT) is a high-frequency weight-bearing tremor of the legs and trunk associated with progressive disability and is often refractory to medications. Case reports suggest that thalamic deep brain stimulation (DBS) is effective. We report 5 female patients with medication-refractory OT who underwent bilateral thalamic DBS at the Mayo Clinic and assess factors associated with a successful DBS outcome.MethodsDemographic, clinical, electrophysiology, and DBS data were abstracted. Outcomes were change in tremor-onset latency, standing time, standing ADLs, and patient and clinician global impression of change (PGIC; CGIC).ResultsAll 5 patients had improved standing time (72 vs 408 seconds, p ≤ 0.001) and improved standing ADLs after surgery, without change in tremor-onset latency (16 vs 75 seconds, p = 0.14). Maximal benefit was reached up to 3 years after surgery and sustained for up to 6 years. CGIC was “much improved” in all; PGIC was “much improved” in 4 and “minimally improved” in 1. There were no major complications. Postoperative electrophysiology (n = 1) showed lower tremor amplitude and slower tremor ramp-up on vs off stimulation.ConclusionsBilateral thalamic DBS improved OT symptoms with benefit lasting up to 6 years. A modest increase in standing time of several minutes was associated with meaningful improvement in standing ADLs. Microlesional effect and bilateral stimulation are likely favorable features, while baseline standing time of several minutes may be unfavorable. These findings may inform clinician and patient counseling and require confirmation in larger studies.

Approach for tunneling the lead in deep brain stimulation

2010 ◽  
Vol 112 (6) ◽  
pp. 1277-1278 ◽  
Author(s):  
Andrew J. Fabiano ◽  
Robert J. Plunkett
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Pulse Generator ◽  
Electrode Placement ◽  
Deep Brain Stimulator ◽  
Electrode Implantation ◽  
Subsequent Operation ◽  
Implantation Procedure ◽  
Deep Brain

The implantation of a deep brain stimulator (DBS) is often a staged procedure that involves stereotactic placement of the neurostimulator electrode, followed by connection of the electrode to a pulse generator during a separate operation. The authors describe a practical technique for the retrograde tunneling of the stimulator lead during the initial electrode implantation procedure. After DBS electrode placement and securing of the lead, the lead is covered with a protective cap and boot, which are then folded back to tunnel a redundant loop of the lead in a retrograde fashion into a subgaleal pocket. This technique facilitates connection of the lead to the pulse generator connecting wire at the subsequent operation and may reduce lead damage.

Operative Technique and Workflow of Deep Brain Stimulation Surgery With Pre-existing Cochlear Implants

2019 ◽  
Vol 19 (2) ◽  
pp. 143-149
Author(s):  
Erik Bolier ◽  
Jessica A Karl ◽  
R Mark Wiet ◽  
Alireza Borghei ◽  
Leo Verhagen Metman ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cochlear Implants ◽  
Brain Stimulation ◽  
Operative Technique ◽  
Case Reports ◽  
Time Frame ◽  
Lead Placement ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Deep Brain

Abstract Background Deep brain stimulation (DBS) surgery in patients with pre-existing cochlear implants (CIs) poses various challenges. We previously reported successful magnetic resonance imaging (MRI)-based, microelectrode recording (MER)-guided subthalamic DBS surgery in a patient with a pre-existing CI. Other case reports have described various DBS procedures in patients with pre-existing CIs using different techniques, leading to varying issues to address. A standardized operative technique and workflow for DBS surgery in the setting of pre-existing CIs is much needed. Objective To provide a standardized operative technique and workflow for DBS lead placement in the setting of pre-existing CIs. Methods Our operative technique is MRI-based and MER-guided, following a workflow involving coordination with a neurotology team to remove and re-implant the internal magnets of the CIs in order to safely perform DBS lead placement, altogether within a 24-h time frame. Intraoperative nonverbal communication with the patient is easily possible using a computer monitor. Results A 65-yr old woman with a 10-yr history of craniocervical dystonia and pre-existing bilateral CIs underwent successful bilateral pallidal DBS surgery at our institution. No merging errors or difficulties in targeting globus pallidus internus were experienced. Also, inactivated CIs do not interfere with MER nor with stimulation, and intraoperative communication with the patient using a computer monitor proved feasible and satisfactory. Conclusion DBS procedures are safe and feasible in patients with pre-existing CIs if precautions are taken following our workflow.

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