Neurostimulators: Potential for excessive heating of deep brain stimulation electrodes during magnetic resonance imaging

Rezai, Ali R.; Finelli, Daniel A.; Rugieri, Paul; Tkach, Jean A.; Nyenhuis, J.A.; Shellock, Frank G.

doi:10.1002/jmri.1212

Cited by 31 publications

(18 citation statements)

References 8 publications

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“…[20][21][22][23][24][25][26][27] Our results confirm that both bilateral STN stimulation in PD and bilateral VIM stimulation in ET are safe and effective treatments for disabling motor symptoms and that they improve activities of daily living. There were too few patients with PD who had leads implanted in the GPi and the VIM to derive conclusions regarding treatment efficacy but safety and adverse events in this small group of patients were included in the analysis reported in this paper.…”

Section: Discussionsupporting

confidence: 63%

Dual channel deep brain stimulation system (Kinetra) for Parkinson's disease and essential tremor: a prospective multicentre open label clinical study

Vesper¹

2002

Journal of Neurology, Neurosurgery &Amp; Psychiatry

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Objectives: To evaluate the safety and efficacy of a new dual channel stimulator (Kinetra) in patients with severe Parkinson's disease (PD) or essential tremor (ET). Methods: 111 patients with PD and 18 with ET were studied. Leads were implanted into the subthalamic nucleus (STN) or internal globus pallidus of patients with the akinetic/rigid type of PD. Leads were implanted into the ventral intermediate nucleus (VIM) of the thalamus or the STN in patients with the tremor dominant type of PD and in those with ET. Technical data on the device and adverse events occurring during the study were documented. Patients were assessed with established and validated clinical scales before surgery and at three and six months' follow up. Results: No device failure or unexpected adverse events occurred during the study. The dual channel stimulator used in stimulation of the STN, internal globus pallidus, and VIM in PD and ET was as safe and effective as the single channel stimulators in use. Mortality, morbidity, and infections were documented in the 129 treated patients. The parameter settings were similar to those usually programmed with single channel stimulators. Time spent in the operating room to implant the Kinetra system was systematically documented. In the PD group, improvement in the unified Parkinson's disease rating scale motor score, decrease in medication OFF periods, and reduced levodopa induced dyskinesia by bilateral STN stimulation were similar to those previously reported with bilaterally applied single channel stimulators. In the ET group upper and lower limb tremor scores were reduced by VIM stimulation. Activities of daily living improved in both disease groups. Conclusion: The Kinetra facilitated bilateral deep brain stimulation implantation surgery and is easy to use. It offers more advantages for the patient than the single channel stimulators; consequently, this new device may be recommended to treat patients with severe PD and ET.

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Section: Discussionsupporting

confidence: 63%

Dual channel deep brain stimulation system (Kinetra) for Parkinson's disease and essential tremor: a prospective multicentre open label clinical study

Vesper¹

2002

Journal of Neurology, Neurosurgery &Amp; Psychiatry

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“…surfaces of the electrode [31][32][33][34] . Heating of the stimulating surfaces in a cardiac pacemaker can cause local degradation of tissue contact that can reduce the effectiveness of the device, but this phenomenon is particularly worrisome for devices placed in the brain, as excessive tissue heating is associated with permanent damage [35,36] .…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging of Implanted Deep Brain Stimulators: Experience in a Large Series

Larson¹,

Richardson²,

Starr³

et al. 2007

Stereotact Funct Neurosurg

108

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Magnetic resonance imaging (MRI) is a commonly used and important imaging modality to evaluate lead location and rule out complications after deep brain stimulation (DBS) surgery. Recent safety concerns have prompted new safety recommendations for the use of MRI in these patients, including a new recommendation to limit the specific absorption rate (SAR) of the MRI sequences used to less than 0.1 W/kg. Following SAR recommendations in real-world situations is problematic for a variety of reasons. We review our experience scanning patients with implanted DBS systems over a 7-year period using a variety of scanning techniques and four scanning platforms. 405 patients with 746 implanted DBS systems were imaged using 1.5-tesla MRI with an SAR of up to 3 W/kg. Many of the DBS systems were imaged multiple times, for a total of 1,071 MRI events in this group of patients with no adverse events. This series strongly suggests that the 0.1 W/kg recommendation for SAR may be unnecessarily low for the prevention of MRI-related adverse events.

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“…Stereotactic X-ray imaging of the skull is considered the most accurate picture of placed electrodes and definitely ruling out MR image distortion due to the heterogeneities of the magnetic field [3,[14][15][16][17] . Thus, postoperative MRI with its potential risk of heating is avoided [18][19][20] .…”

Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson’s Disease: Usefulness of Intraoperative Radiological Guidance

Derrey

Maltête²,

Chastan³

et al. 2008

Stereotact Funct Neurosurg

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Background: In our stereotactic procedure, intraoperative radiological documentation of electrode localization is performed using the Stereoplan. The aim of the study was to evaluate its accuracy. Patients and Methods: Data of 20 consecutive patients, treated for Parkinson’s disease by implantation of deep brain stimulators into the subthalamic nucleus, were collected prospectively. During surgery, Stereoplan coordinates of the tip of the central macroelectrodes were compared with intended coordinates along the central trajectory at 4 levels: (1) 10 mm above the anatomical target, (2) in the target, (3) in the substantia nigra pars reticulata, and (4) at the depth of contact 1. Before the frame’s removal, Stereoplan coordinates of the contacts of the definitive electrode were compared with postoperative MRI coordinates. The mean of the differences was calculated in the x-, y-, and z-axis. Clinical results at 6 months were recorded.Results: The mean of the differences between Stereoplan coordinates and intended coordinates for the macroelectrodes was lower than 1 mm. A submillimeter difference was also found for the definitive contacts. At 6 months, the Unified Parkinson‘s Disease Rating Scale III score improved by 70.6% compared with the baseline score. Dyskinesia and motor fluctuations decreased by 85.7 and 87%, respectively (p < 0.0001). Conclusion: Stereoplan could be considered an accurate intraoperative radiological system which assures the correct position of the electrode in the anatomical target.

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Neurostimulators: Potential for excessive heating of deep brain stimulation electrodes during magnetic resonance imaging

Cited by 31 publications

References 8 publications

Dual channel deep brain stimulation system (Kinetra) for Parkinson's disease and essential tremor: a prospective multicentre open label clinical study

Dual channel deep brain stimulation system (Kinetra) for Parkinson's disease and essential tremor: a prospective multicentre open label clinical study

Magnetic Resonance Imaging of Implanted Deep Brain Stimulators: Experience in a Large Series

Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson’s Disease: Usefulness of Intraoperative Radiological Guidance

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