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.

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.

Technical analysis of dual channel pulse generators used in deep brain stimulation; a safety evaluation

2008 ◽  
Vol 151 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Hermann Lanmüller ◽  
Johann Wernisch ◽  
François Alesch
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Safety Evaluation ◽  
Technical Analysis ◽  
Pulse Generators ◽  
Dual Channel ◽  
Deep Brain

scholarly journals Deep Brain Stimulation and Electromagnetic Interference

2021 ◽  
pp. 106577
Author(s):  
Shervin Rahimpour ◽  
Musa Kiyani ◽  
Sarah E. Hodges ◽  
Dennis Turner
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Electromagnetic Interference ◽  
Deep Brain

scholarly journals iHandU: A Novel Quantitative Wrist Rigidity Evaluation Device for Deep Brain Stimulation Surgery

Sensors ◽  
2020 ◽  
Vol 20 (2) ◽  
pp. 331 ◽  
Author(s):  
Elodie Múrias Lopes ◽  
Maria do Carmo Vilas-Boas ◽  
Duarte Dias ◽  
Maria José Rosas ◽  
Rui Vaz ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Lessons Learned ◽  
Wrist Flexion ◽  
Stimulation Parameters ◽  
Average Accuracy ◽  
Gyroscope Sensor ◽  
Work Done ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Deep brain stimulation (DBS) surgery is the gold standard therapeutic intervention in Parkinson’s disease (PD) with motor complications, notwithstanding drug therapy. In the intraoperative evaluation of DBS’s efficacy, neurologists impose a passive wrist flexion movement and qualitatively describe the perceived decrease in rigidity under different stimulation parameters and electrode positions. To tackle this subjectivity, we designed a wearable device to quantitatively evaluate the wrist rigidity changes during the neurosurgery procedure, supporting physicians in decision-making when setting the stimulation parameters and reducing surgery time. This system comprises a gyroscope sensor embedded in a textile band for patient’s hand, communicating to a smartphone via Bluetooth and has been evaluated on three datasets, showing an average accuracy of 80%. In this work, we present a system that has seen four iterations since 2015, improving on accuracy, usability and reliability. We aim to review the work done so far, outlining the iHandU system evolution, as well as the main challenges, lessons learned, and future steps to improve it. We also introduce the last version (iHandU 4.0), currently used in DBS surgeries at São João Hospital in Portugal.

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

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

scholarly journals Letter: Evaluation and Surgical Treatment of Functional Neurosurgery Patients With Implanted Deep Brain Stimulation and Vagus Nerve Stimulation Pulse Generators During the COVID-19 Pandemic

Neurosurgery ◽  
2020 ◽  
Vol 87 (2) ◽  
pp. E222-E226 ◽  
Author(s):  
Robert E Gross ◽  
Cathrin M Buetefisch ◽  
Svjetlana Miocinovic ◽  
Katie L Bullinger ◽  
Michael S Okun ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Surgical Treatment ◽  
Vagus Nerve ◽  
Brain Stimulation ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Functional Neurosurgery ◽  
Pulse Generators ◽  
Stimulation Pulse ◽  
Deep Brain

Gait worsening and the microlesion effect following deep brain stimulation for essential tremor

2019 ◽  
Vol 90 (8) ◽  
pp. 913-919 ◽  
Author(s):  
Ryan Roemmich ◽  
Jaimie A Roper ◽  
Robert S Eisinger ◽  
Jackson N Cagle ◽  
Lauren Maine ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Repeated Measures ◽  
Walking Speed ◽  
Stimulation Parameters ◽  
Gait Parameters ◽  
Before And After ◽  
Walking Speeds ◽  
Deep Brain

ObjectiveTo investigate the effects of unilateral thalamic deep brain stimulation (DBS) on walking in persons with medication-refractory essential tremor (ET).MethodsWe performed laboratory-based gait analyses on 24 persons with medication-refractory ET before and after unilateral thalamic DBS implantation. Normal and tandem walking parameters were analysed across sessions (PRE-DBS/DBS OFF/DBS ON) by repeated measures analyses of variance. Pearson’s correlations assessed whether changes in walking after DBS were global (ie, related across gait parameters). Baseline characteristics, lead locations and stimulation parameters were analysed as possible contributors to gait effects.ResultsDBS minimally affected gait at the cohort level. However, 25% of participants experienced clinically meaningful gait worsening. Walking speed decreased by >30% in two participants and by >10% in four others. Decreased walking speed correlated with increased gait variability, indicating global gait worsening in affected participants. The worsening persisted even after the stimulation was turned off. Participants with worse baseline tandem walking performance may be more likely to experience post-DBS gait worsening; the percentage of tandem missteps at baseline was nearly three times higher and tandem walking speeds were approximately 30% slower in participants who experienced gait worsening. However, these differences in tandem walking in persons with gait worsening as compared with those without worsening were not statistically significant. Lead locations and stimulation parameters were similar in participants with and without gait worsening.ConclusionGlobal gait worsening occurred in 25% of participants with unilateral DBS for medication-refractory ET. The effect was present on and off stimulation, likely indicating a microlesion effect.

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