Implantation of bilateral deep brain stimulators in patients with Parkinson disease and preexisting cardiac pacemakers

Report of two cases

Restricted access

✓ Deep brain stimulation (DBS) has become an important modality in the treatment of refractory Parkinson disease (PD). In patients with comorbid arrhythmias requiring cardiac pacemakers, DBS therapy is complicated by concerns over a possible electrical interaction between the devices (or with device programming) and the inability to use magnetic resonance imaging guidance for implantation. The authors report two cases of PD in which patients with preexisting cardiac pacemakers underwent successful implantation of bilateral DBS electrodes in the subthalamic nucleus (STN).

Each patient underwent computerized tomography—guided stereotactic frame—based placement of DBS electrodes with microelectrode recording. Both extension wires were passed from the right side of the head and neck (contralateral to the pacemaker) to place the cranial pulse generators subcutaneously in the left and right abdomen. The cranial pulse generators were placed farther than 6 in from the cardiac pacemaker and from each other to decrease the chance of interference between the devices during telemetry reprogramming.

Postoperative management involved brain stimulator programming sessions with simultaneous cardiological monitoring of pacemaker function and cardiac rhythm. No interference was noted at any time, and proper pacemaker function was maintained throughout the follow-up period. With bilateral STN stimulation, both patients experienced a dramatic improvement in their PD symptoms, including elimination of dyskinesias, reduction of “off” severity, and increase of “on” duration.

With some modifications of implantation strategy, two patients with cardiac pacemakers were successfully treated with bilateral DBS STN therapy for refractory PD. To our knowledge, this is the first report on patients with cardiac pacemakers undergoing brain stimulator implantation.

Article Information

Address reprint requests to: Robert R. Goodman, M.D., Ph.D., Department of Neurological Surgery, Neurological Institute of New York, Columbia College of Physicians and Surgeons, 710 West 168th Street, Box 99, New York, New York 10032. email: rrg2@columbia.edu.

© AANS, except where prohibited by US copyright law.

Headings

References

  • 1.

    Benabid ALPollak PGross Cet al: Acute and long-term effects of subthalamic nucleus stimulation in Parkinson's disease. Stereotact Funct Neurosurg 62:76841994Benabid AL Pollak P Gross C et al: Acute and long-term effects of subthalamic nucleus stimulation in Parkinson's disease. Stereotact Funct Neurosurg 62:76–84 1994

  • 2.

    Benedini GCaradonna EAlfieri Oet al: Impiego combinato di pacemaker antitachicardico automatico e cardioverter-defibrillatore automatico impiantabile nella tachicardia ventricolare sustenuta ricorrente refrattaria ai farmaci. G Ital Cardiol 19:8899001989Benedini G Caradonna E Alfieri O et al: Impiego combinato di pacemaker antitachicardico automatico e cardioverter-defibrillatore automatico impiantabile nella tachicardia ventricolare sustenuta ricorrente refrattaria ai farmaci. G Ital Cardiol 19:889–900 1989

  • 3.

    Cesario ASPalermo PBaragli Det al: Impianto concomitance di defibrillatore automatico di ultima generazione e pacemaker bicamerale. G Ital Cardiol 28:8788861998Cesario AS Palermo P Baragli D et al: Impianto concomitance di defibrillatore automatico di ultima generazione e pacemaker bicamerale. G Ital Cardiol 28:878–886 1998

  • 4.

    Davidson ARosewarne F: Pacemaker inhibition by calf stimulator. Anaesth Intensive Care 23:2582591995Davidson A Rosewarne F: Pacemaker inhibition by calf stimulator. Anaesth Intensive Care 23:258–259 1995

  • 5.

    Deep-Brain Stimulation for Parkinson's Disease Study Group: Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med 345:9569632001Deep-Brain Stimulation for Parkinson's Disease Study Group: Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med 345:956–963 2001

  • 6.

    Farwick JLvan Laar TLeenders K: A cardiac pacemaker and thalamic deep brain stimulation (DBS) in the same patient. A case report. Mov Disord 17 (Suppl 5):S1822002 (Abstract)Farwick JL van Laar T Leenders K: A cardiac pacemaker and thalamic deep brain stimulation (DBS) in the same patient. A case report. Mov Disord 17 (Suppl 5):S182 2002 (Abstract)

  • 7.

    Ford BWinfield LPullman SLet al: Subthalamic nucleus stimulation in advanced Parkinson's disease: blinded assessments at one year followup. J Neurol Neurosurg Psychiatry 75:125512592004Ford B Winfield L Pullman SL et al: Subthalamic nucleus stimulation in advanced Parkinson's disease: blinded assessments at one year followup. J Neurol Neurosurg Psychiatry 75:1255–1259 2004

  • 8.

    Green JDSchuh MJMaddern BRet al: Cochlear implantation in Jervell and Lange-Nielsen syndrome. Ann Otol Rhinol Laryngol Suppl 185:27282000Green JD Schuh MJ Maddern BR et al: Cochlear implantation in Jervell and Lange-Nielsen syndrome. Ann Otol Rhinol Laryngol Suppl 185:27–28 2000

  • 9.

    Iyer RGnanadurai TVForsey P: Management of cardiac pacemaker in a patient with spinal cord stimulator implant. Pain 74:3333351998Iyer R Gnanadurai TV Forsey P: Management of cardiac pacemaker in a patient with spinal cord stimulator implant. Pain 74:333–335 1998

  • 10.

    Just HOstergaard K: Health-related quality of life in patients with advanced Parkinson's disease treated with deep brain stimulation of the subthalamic nuclei. Mov Disord 17:5395452002Just H Ostergaard K: Health-related quality of life in patients with advanced Parkinson's disease treated with deep brain stimulation of the subthalamic nuclei. Mov Disord 17:539–545 2002

  • 11.

    Kumar RLozano AMKim YJet al: Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's disease. Neurology 51:8508551998Kumar R Lozano AM Kim YJ et al: Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's disease. Neurology 51:850–855 1998

  • 12.

    Limousin PKrack PPollak Pet al: Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 339:110511111998Limousin P Krack P Pollak P et al: Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 339:1105–1111 1998

  • 13.

    Limousin PPollak PBenazzouz Aet al: Effect of parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet 345:91951995Limousin P Pollak P Benazzouz A et al: Effect of parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet 345:91–95 1995

  • 14.

    Monahan KCasavant DRasmussen Cet al: Combined use of a true-bipolar sensing implantable cardioverter defibrillator in a patient having a prior implantable spinal cord stimulator for intractable pain. Pacing Clin Electrophysiol 21:266926721998Monahan K Casavant D Rasmussen C et al: Combined use of a true-bipolar sensing implantable cardioverter defibrillator in a patient having a prior implantable spinal cord stimulator for intractable pain. Pacing Clin Electrophysiol 21:2669–2672 1998

  • 15.

    Nutt JGAnderson VCPeacock JHet al: DBS and diathermy interaction induces severe CNS damage. Neurology 56:138413862001Nutt JG Anderson VC Peacock JH et al: DBS and diathermy interaction induces severe CNS damage. Neurology 56:1384–1386 2001

  • 16.

    Obwegeser AAUitti RJTurk MFet al: Simultaneous thalamic deep brain stimulation and implantable cardioverter-defibrillator. Mayo Clin Proc 76:87892001Obwegeser AA Uitti RJ Turk MF et al: Simultaneous thalamic deep brain stimulation and implantable cardioverter-defibrillator. Mayo Clin Proc 76:87–89 2001

  • 17.

    O'Flaherty DWardill MAdams AP: Inadvertent suppression of a fixed rate ventricular pacemaker using a peripheral nerve stimulator. Anesthesia 48:6876891993O'Flaherty D Wardill M Adams AP: Inadvertent suppression of a fixed rate ventricular pacemaker using a peripheral nerve stimulator. Anesthesia 48:687–689 1993

  • 18.

    Pinter MMAlesch FMurg Met al: Deep brain stimulation of the subthalamic nucleus for control of extrapyramidal features in advanced idiopathic Parkinson's disease: one year follow-up. J Neural Transm 106:6937091999Pinter MM Alesch F Murg M et al: Deep brain stimulation of the subthalamic nucleus for control of extrapyramidal features in advanced idiopathic Parkinson's disease: one year follow-up. J Neural Transm 106:693–709 1999

  • 19.

    Pollak PBenabid ALGross Cet al: Effets de la stimulation du noyau sous-thalamique dans la maladie de Parkinson. Rev Neurol 149:1751761993Pollak P Benabid AL Gross C et al: Effets de la stimulation du noyau sous-thalamique dans la maladie de Parkinson. Rev Neurol 149:175–176 1993

  • 20.

    Pyatt JRTrenbath DChester Met al: The simultaneous use of a biventricular implantable cardioverter defibrillator (ICD) and transcutaneous electrical nerve stimulation (TENS) unit: implications for device interaction. Europace 5:91932003Pyatt JR Trenbath D Chester M et al: The simultaneous use of a biventricular implantable cardioverter defibrillator (ICD) and transcutaneous electrical nerve stimulation (TENS) unit: implications for device interaction. Europace 5:91–93 2003

  • 21.

    Richard JPConil JMAntonini Aet al: Interaction entre bistouri electrique et stimulateur cardiaque. Ann Fr Anesth Reanim 5:72731986Richard JP Conil JM Antonini A et al: Interaction entre bistouri electrique et stimulateur cardiaque. Ann Fr Anesth Reanim 5:72–73 1986

  • 22.

    Rosenow JMTarkin HZias Eet al: Simultaneous use of bilateral subthalamic nucleus stimulators and an implantable cardiac defibrillator. Case report. J Neurosurg 99:1671692003Rosenow JM Tarkin H Zias E et al: Simultaneous use of bilateral subthalamic nucleus stimulators and an implantable cardiac defibrillator. Case report. J Neurosurg 99:167–169 2003

  • 23.

    Saint-Cyr JAHoque TPereira LCet al: Localization of clinically effective stimulating electrodes in the human subthalamic nucleus on magnetic resonance imaging. J Neurosurg 97:115211662002Saint-Cyr JA Hoque T Pereira LC et al: Localization of clinically effective stimulating electrodes in the human subthalamic nucleus on magnetic resonance imaging. J Neurosurg 97:1152–1166 2002

  • 24.

    Starr PAChristine CWTheodosopoulos PVet al: Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations. J Neurosurg 97:3703872002Starr PA Christine CW Theodosopoulos PV et al: Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations. J Neurosurg 97:370–387 2002

  • 25.

    Sterio DZonenshayn MMogilner AYet al: Neurophysiological refinement of subthalamic nucleus targeting. Neurosurgery 50:58692002Sterio D Zonenshayn M Mogilner AY et al: Neurophysiological refinement of subthalamic nucleus targeting. Neurosurgery 50:58–69 2002

  • 26.

    Tavernier RFonteyne WVandewalle Vet al: Use of an implantable cardioverter defibrillator in a patient with two implanted neurostimulators for severe Parkinson's disease. Pacing Clin Electrophysiol 23:105710592000Tavernier R Fonteyne W Vandewalle V et al: Use of an implantable cardioverter defibrillator in a patient with two implanted neurostimulators for severe Parkinson's disease. Pacing Clin Electrophysiol 23:1057–1059 2000

  • 27.

    Volkmann JAllert NVoges Jet al: Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD. Neurology 56:5485512001Volkmann J Allert N Voges J et al: Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD. Neurology 56:548–551 2001

  • 28.

    Yamamoto TKatayama YFukaya Cet al: Thalamotomy caused by cardioversion in a patient treated with deep brain stimulation. Stereotact Funct Neurosurg 74:73822000Yamamoto T Katayama Y Fukaya C et al: Thalamotomy caused by cardioversion in a patient treated with deep brain stimulation. Stereotact Funct Neurosurg 74:73–82 2000

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 78 78 16
Full Text Views 154 154 0
PDF Downloads 36 36 0
EPUB Downloads 0 0 0

PubMed

Google Scholar