3-Tesla MRI in patients with fully implanted deep brain stimulation devices: a preliminary study in 10 patients

2017 ◽  
Vol 127 (4) ◽  
pp. 892-898 ◽  
Author(s):  
Francesco Sammartino ◽  
Vibhor Krishna ◽  
Tejas Sankar ◽  
Jason Fisico ◽  
Suneil K. Kalia ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Pulse Generator ◽  
Safety Data ◽  
Phantom Study ◽  
Maximum Temperature ◽  
Clinical Safety ◽  
Internal Pulse Generator ◽  
Neurological Effects ◽  
Deep Brain

OBJECTIVEThe aim of this study was to evaluate the safety of 3-T MRI in patients with implanted deep brain stimulation (DBS) systems.METHODSThis study was performed in 2 phases. In an initial phantom study, a Lucite phantom filled with tissue-mimicking gel was assembled. The system was equipped with a single DBS electrode connected to an internal pulse generator. The tip of the electrode was coupled to a fiber optic thermometer with a temperature resolution of 0.1°C. Both anatomical (T1- and T2-weighted) and functional MRI sequences were tested. A temperature change within 2°C from baseline was considered safe. After findings from the phantom study suggested safety, 10 patients with implanted DBS systems targeting various brain areas provided informed consent and underwent 3-T MRI using the same imaging sequences. Detailed neurological evaluations and internal pulse generator interrogations were performed before and after imaging.RESULTSDuring phantom testing, the maximum temperature increase was registered using the T2-weighted sequence. The maximal temperature changes at the tip of the DBS electrode were < 1°C for all sequences tested. In all patients, adequate images were obtained with structural imaging, although a significant artifact from lead connectors interfered with functional imaging quality. No heating, warmth, or adverse neurological effects were observed.CONCLUSIONSTo the authors' knowledge, this was the first study to assess the clinical safety of 3-T MRI in patients with a fully implanted DBS system (electrodes, extensions, and pulse generator). It provided preliminary data that will allow further examination and assessment of the safety of 3-T imaging studies in patients with implanted DBS systems. The authors cannot advocate widespread use of this type of imaging in patients with DBS implants until more safety data are obtained.

scholarly journals Placement of the Internal Pulse Generator for Deep Brain Stimulation in the Upper Back to Prevent Fracture of the Extension Wire due to Generator Rotation: Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Ankur Garg ◽  
Avinash L. Mohan ◽  
P. Charles Garell
Keyword(s):  
Case Report ◽  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Surgical Procedure ◽  
Pulse Generator ◽  
Potential Complication ◽  
Hardware Failure ◽  
Internal Pulse Generator ◽  
Deep Brain

Deep brain stimulation (DBS) is a common surgical procedure used for the treatment of Parkinson's disease (PD) and essential tremor. A potential complication of this procedure is hardware failure. The authors report a case of DBS hardware failure in which repeated fractures of the extension wire were caused by abnormal rotational movements of the IPG placed in the loose subclavicular tissue of an overweight female. Implantation of the IPG in the suprascapular area prevented further extension wire fractures. This strategy may be especially relevant in overweight females with loose subclavicular tissue.

Reuse of Internal Pulse Generator in Cases of Infection after Deep Brain Stimulation Surgery

2014 ◽  
Vol 92 (3) ◽  
pp. 140-144 ◽  
Author(s):  
Selcuk Gocmen ◽  
Ozkan Celiker ◽  
Abdullah Topcu ◽  
Aikaterini Panteli ◽  
Goksemin Acar ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Pulse Generator ◽  
Internal Pulse Generator ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

3-Tesla MRI of deep brain stimulation patients: safety assessment of coils and pulse sequences

2020 ◽  
Vol 132 (2) ◽  
pp. 586-594 ◽  
Author(s):  
Alexandre Boutet ◽  
Ileana Hancu ◽  
Utpal Saha ◽  
Adrian Crawley ◽  
David S. Xu ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Safety Assessment ◽  
Pulse Generator ◽  
Pulse Sequences ◽  
Safety Data ◽  
Experimental Conditions ◽  
Weighted Sequences ◽  
Head Coil ◽  
Deep Brain

OBJECTIVEPhysicians are more frequently encountering patients who are treated with deep brain stimulation (DBS), yet many MRI centers do not routinely perform MRI in this population. This warrants a safety assessment to improve DBS patients’ accessibility to MRI, thereby improving their care while simultaneously providing a new tool for neuromodulation research.METHODSA phantom simulating a patient with a DBS neuromodulation device (DBS lead model 3387 and IPG Activa PC model 37601) was constructed and used. Temperature changes at the most ventral DBS electrode contacts, implantable pulse generator (IPG) voltages, specific absorption rate (SAR), and B1+rms were recorded during 3-T MRI scanning. Safety data were acquired with a transmit body multi-array receive and quadrature transmit-receive head coil during various pulse sequences, using numerous DBS configurations from “the worst” to “the most common.”In addition, 3-T MRI scanning (T1 and fMRI) was performed on 41 patients with fully internalized and active DBS using a quadrature transmit-receive head coil. MR images, neurological examination findings, and stability of the IPG impedances were assessed.RESULTSIn the phantom study, temperature rises at the DBS electrodes were less than 2°C for both coils during 3D SPGR, EPI, DTI, and SWI. Sequences with intense radiofrequency pulses such as T2-weighted sequences may cause higher heating (due to their higher SAR). The IPG did not power off and kept a constant firing rate, and its average voltage output was unchanged. The 41 DBS patients underwent 3-T MRI with no adverse event.CONCLUSIONSUnder the experimental conditions used in this study, 3-T MRI scanning of DBS patients with selected pulse sequences appears to be safe. Generally, T2-weighted sequences (using routine protocols) should be avoided in DBS patients. Complementary 3-T MRI phantom safety data suggest that imaging conditions that are less restrictive than those used in the patients in this study, such as using transmit body multi-array receive coils, may also be safe. Given the interplay between the implanted DBS neuromodulation device and the MRI system, these findings are specific to the experimental conditions in this study.

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.

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

scholarly journals Design of a Small Modified Minkowski Fractal Antenna for Passive Deep Brain Stimulation Implants

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Sara Manafi ◽  
Hai Deng
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Performance Metrics ◽  
Pulse Generator ◽  
Fractal Antenna ◽  
Dual Frequency ◽  
Frequency Bands ◽  
Received Power ◽  
Minkowski Fractal ◽  
Deep Brain

A small planar modified Minkowski fractal antenna is designed and simulated in dual frequency bands (2.4 and 5.8 GHz) for wireless energy harvesting by deep brain stimulation (DBS) devices. The designed antenna, physically being confined inside a miniaturized structure, can efficiently convert the wireless signals in dual ISM frequency bands to the energy source to recharge the DBS battery or power the pulse generator directly. The performance metrics such as the return loss, the specific absorption rate (SAR), and the radiation pattern within skin and muscle-fat-skin tissues are evaluated for the designed antenna. The gain of the proposed antenna is 3.2 dBi at 2.4 GHz and 4.7 dBi at 5.8 GHz; also the averaged SAR of the antenna in human body tissue is found to be well below the legally allowed limit at both frequency bands. The link budget shows the received power at the distance of 25 cm at 2.4 GHz and 5.8 GHz are around 0.4 mW and 0.04 mW, which can empower the DBS implant. The large operational bandwidth, the physical compactness, and the efficiency in wireless signal reception make this antenna suitable in being used in implanted biomedical devices such as DBS pulse generators.

scholarly journals Deep brain stimulator implantation in a diagnostic MRI suite: infection history over a 10-year period

2017 ◽  
Vol 126 (1) ◽  
pp. 108-113 ◽  
Author(s):  
Alastair J. Martin ◽  
Paul S. Larson ◽  
Nathan Ziman ◽  
Nadja Levesque ◽  
Monica Volz ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Operating Room ◽  
Infection Rate ◽  
Brain Stimulation ◽  
Pulse Generator ◽  
Surgical Site Infections ◽  
Air Filtration ◽  
Staphylococcus Epidermis ◽  
Mri Guided ◽  
Deep Brain

OBJECTIVE The objective of this study was to assess the incidence of postoperative hardware infection following interventional (i)MRI–guided implantation of deep brain stimulation (DBS) electrodes in a diagnostic MRI scanner. METHODS A diagnostic 1.5-T MRI scanner was used over a 10-year period to implant DBS electrodes for movement disorders. The MRI suite did not meet operating room standards with respect to airflow and air filtration but was prepared and used with conventional sterile procedures by an experienced surgical team. Deep brain stimulation leads were implanted while the patient was in the magnet, and patients returned 1–3 weeks later to undergo placement of the implantable pulse generator (IPG) and extender wire in a conventional operating room. Surgical site infections requiring the removal of part or all of the DBS system within 6 months of implantation were scored as postoperative hardware infections in a prospective database. RESULTS During the 10-year study period, the authors performed 164 iMRI-guided surgical procedures in which 272 electrodes were implanted. Patients ranged in age from 7 to 78 years, and an overall infection rate of 3.6% was found. Bacterial cultures indicated Staphylococcus epidermis (3 cases), methicillin-susceptible Staphylococcus aureus (2 cases), or Propionibacterium sp. (1 case). A change in sterile practice occurred after the first 10 patients, leading to a reduction in the infection rate to 2.6% (4 cases in 154 procedures) over the remainder of the procedures. Of the 4 infections in this patient subset, all occurred at the IPG site. CONCLUSIONS Interventional MRI–guided DBS implantation can be performed in a diagnostic MRI suite with an infection risk comparable to that reported for traditional surgical placement techniques provided that sterile procedures, similar to those used in a regular operating room, are practiced.

Deep brain stimulation: custom-made silicone-coated pulse-generator implantation after allergic reaction to generator compounds

2017 ◽  
Vol 160 (2) ◽  
pp. 385-387
Author(s):  
Judith Anthofer ◽  
Andreas Herbst ◽  
Annettte Janzen ◽  
Max Lange ◽  
Alexander Brawanski ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Allergic Reaction ◽  
Brain Stimulation ◽  
Pulse Generator ◽  
Custom Made ◽  
Deep Brain

scholarly journals Recharging Difficulty With Pulse Generator After Deep Brain Stimulation: A Case Series of Five Patients

2021 ◽  
Vol 15 ◽  
Author(s):  
Hongyang Li ◽  
Daoqing Su ◽  
Yijie Lai ◽  
Xinmeng Xu ◽  
Chencheng Zhang ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Pulse Generator ◽  
Rare Complication ◽  
Subcutaneous Fat ◽  
Treatment Strategies ◽  
Case Series ◽  
Initial Surgery ◽  
Rechargeable Cell ◽  
Deep Brain

Background: Deep brain stimulation (DBS) is a well-established treatment for a variety of movement disorders. Rechargeable cell technology was introduced to pulse generator more than 10 years ago and brought great benefits to patients. However, with the widespread use of rechargeable implanted pulse generators (r-IPGs), a new hardware complication, when charging the r-IPG has been difficult, was encountered.Objective: The aims of this study were to report five cases confronted with r-IPG charging difficulty postoperatively and to explore the predisposing factors and treatment strategies for this rare complication.Methods: We retrospectively reviewed our DBS patient database for those who were implanted with r-IPGs. From 2012, we identified a total of 1,226 patients, with five of them experiencing charging difficulties after surgery. Detailed patient profiles and clinical procedures were scrutinized and reviewed.Results: All the charging problems were resolved by reoperation. Cases 1 and 2 required their r-IPGs to be anchored to the muscle and fascia. Cases 3 and 4 had their r-IPGs inserted in the wrong orientation at the initial surgery, which was resolved by turning around the r-IPGs at the revision surgery. Case 5, in which we propose that the thick subcutaneous fat layer blocked the connection between the r-IPG and the recharger, required a second operation to reposition the r-IPG in a shallow layer underneath the skin. For all cases, the charging problems were resolved without reoccurrences to date.Conclusion: Our case series indicates a novel hardware complication of DBS surgery, which had been rarely reported before. In this preliminary study, we describe several underlying causes of this complication and treatment methods.

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