Short circuit in deep brain stimulation

Clinical article

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Object

The authors undertook this study to investigate the incidence, cause, and clinical influence of short circuits in patients treated with deep brain stimulation (DBS).

Methods

After the incidental identification of a short circuit during routine follow-up, the authors initiated a policy at their institution of routinely evaluating both therapeutic impedance and system impendence at every outpatient DBS follow-up visit, irrespective of the presence of symptoms suggesting possible system malfunction. This study represents a report of their findings after 1 year of this policy.

Results

Implanted DBS leads exhibiting short circuits were identified in 7 patients (8.9% of the patients seen for outpatient follow-up examinations during the 12-month study period). The mean duration from DBS lead implantation to the discovery of the short circuit was 64.7 months. The symptoms revealing short circuits included the wearing off of therapeutic effect, apraxia of eyelid opening, or dysarthria in 6 patients with Parkinson disease (PD), and dystonia deterioration in 1 patient with generalized dystonia. All DBS leads with short circuits had been anchored to the cranium using titanium miniplates. Altering electrode settings resulted in clinical improvement in the 2 PD cases in which patients had specific symptoms of short circuits (2.5%) but not in the other 4 cases. The patient with dystonia underwent repositioning and replacement of a lead because the previous lead was located too anteriorly, but did not experience symptom improvement.

Conclusions

In contrast to the sudden loss of clinical efficacy of DBS caused by an open circuit, short circuits may arise due to a gradual decrease in impedance, causing the insidious development of neurological symptoms via limited or extended potential fields as well as shortened battery longevity. The incidence of short circuits in DBS may be higher than previously thought, especially in cases in which DBS leads are anchored with miniplates. The circuit impedance of DBS should be routinely checked, even after a long history of DBS therapy, especially in cases of miniplate anchoring.

Abbreviations used in this paper:DBS = deep brain stimulation; GPi = globus pallidus internus; MER = microelectrode recording; PD = Parkinson disease; STN = subthalamic nucleus.

Article Information

Address correspondence to: Yasushi Miyagi, M.D., Ph.D., Department of Stereotactic and Functional Neurosurgery, Kaizuka Hospital, 7-7-27 Hakozaki, Higashi-ku, Fukuoka 812-0053, Japan. email: yamiyagi@digital.med.kyushu-u.ac.jp.

Please include this information when citing this paper: published online September 7, 2012; DOI: 10.3171/2012.8.JNS112073.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Number of DBS leads implanted at Kaizuka Hospital since 1996, with the time of implantation surgery and discovery of short-circuit cases. The gray bars indicate the number of leads implanted in each year. The solid line indicates the cumulative total of leads implanted, and the dashed line shows the cumulative number of leads anchored by miniplate. The horizontal lines under the graph indicate the duration from lead implantation (left end) to the discovery of the short circuit (right end) in each case. Changing electrode settings improved efficacy in 2 cases (open circles, symptomatic short circuits) but not in the other 4 cases (closed circles, asymptomatic short circuits) of PD. The closed square (Case 7) indicates dystonia.

  • View in gallery

    Radiograph and enlargement showing miniplate anchoring and the site of connection between the DBS lead and extension cable. The area outlined with a white rectangle in (A) is shown in an enlarged view in (B). The connection (double-headed arrow) was placed in the parietal region above the superior temporal line.

  • View in gallery

    Schematic drawing presenting examples of potential fields generated by bipolar stimulation with various patterns of short circuits. The gray areas (around cathode) and unshaded outlined areas (around anode) indicate the intensities of the potential fields of negative and positive voltage, respectively. A: Intended therapeutic potential field induced by Contact 1 as a cathode and Contact 2 as an anode in a case with no short circuit. The therapeutic effect around a cathode is represented by the gray scale. B–E: Examples of unintended potential fields postulated in cases of various patterns of short circuit. A short circuit straddling the anode (B) causes a potential field of mirror image spreading beyond the anode. A short circuit in the contact next to the cathode (C) produces an extended distribution of the potential field spreading in the counter direction of the anode. A short circuit involving an anode (D) produces a limited potential field. A short circuit between a cathode and an anode (E) does not produce any therapeutic potential field.

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