Evaluation of Electromagnetic Incompatibility Concerns for Deep Brain Stimulators

Kelly Dustin

Disclosures

J Neurosci Nurs. 2008;40(5):299-303. 

In This Article

Background

Early surgical techniques for treating movement disorders that remain in use today include thalamotomy for tremor and pallidotomy for dystonia and for signs and symptoms of Parkinson disease. Prior to deep brain stimulation, stereotactic surgical ablation techniques were used to treat dyskinesia, dystonia, tremor, and Parkinsonian signs. Although effective, treating these disorders with surgical ablation of affected regions of the brain does not allow for postoperative adjustments following improved therapeutic response. Implanting a DBS device at specific sites allows for individualized programming of stimulator impulse amplitude and frequency for optimal symptom management. For example, a DBS may be placed in the thalamic region for tremor control, in the pallidal region for dystonia, and in the pallidal or subthalamic regions for Parkinsonian signs (Reynolds, Terry, Mark, Prieto, & Mueller, 2000).

Deep brain stimulation offers a system that is both reversible and programmable to control many signs and symptoms of movement disorder. As those are controlled, DBS afford an opportunity for lowering the medication dose and can consequently reduce or eliminate dyskinesias. DBS do not improve cognitive or psychiatric symptoms, on-period freezing, swallowing difficulties, speech problems, or poor balance.

Therapeutic benefit is directly related to electrode placement precision. The subthalamic nucleus appears to be the most effective site for electrode contact in Parkinson disease (Hamel et al., 2003). The optimal electrode placement for symptom control for essential tremor, or possibly for tremor-predominant Parkinson disease, is a specific site in the thalamus known as the ventral intermediate nucleus (Chen, Hua, Smith, & Shadmehr, 2006). Dystonia is most responsive to stimulation of the globus pallidus (Vidailhet el al., 2005). Brain mapping, scanning, and placement of electrodes in an awake patient allow for intraoperative confirmation of appropriate microelectrode placement for maximum benefit (Reynolds et al., 2000).

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