Cochlear implant should not be absolute contraindication for electroconvulsive therapy and transcranial magnetic stimulation

Jensen, Kristian H. R.; Navntoft, Charlotte Amalie; Sindahl, Camilla Hjortdal; Cayé‐Thomasen, Per; Jørgensen, Martin Balslev

doi:10.1016/j.brs.2020.08.007

Cited by 6 publications

(8 citation statements)

References 9 publications

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“…19 Several case reports and cadaveric studies have shown sustained implant functionality following both ipsilateral and bilateral ECT. [18][19][20] Similarly, Studer et al 13 reported a case combining monopolar cautery use and transcranial electrical stimulation (TES) during spine surgery. Transcutaneous leads were placed within 10 cm of the implant and stimuli were performed as a train of 6 pulses with maximum amplitude of 430 V. No change in CI functionality was noted postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Historically, electroconvulsive therapy (ECT) has been contraindicated for CI patients due to similar concerns as monopolar cautery. [2][3][4] When comparing monopolar cautery and ECT, monopolar cautery can generate up to 400 V 17 while ECT typically ranges from 70 to 120 V. 18 Despite the lower voltage, the electrode lead placement is typically much closer to the implant site in ECT. Performing unilateral ECT opposite the CI has been suggested as the standard of care when a patient has a unilateral implant, and this management modality cannot be avoided.…”

Section: Discussionmentioning

confidence: 99%

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Monopolar Cautery Use in Pediatric Cochlear Implant Users

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Chapel

Silva

et al. 2022

Otolaryngol.--head neck surg.

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Objectives To determine the incidence and impact of monopolar cautery use in a cohort of pediatric cochlear implant (CI) users. Study Design Case series from a retrospective chart review and a systematic review of the literature. Setting Tertiary academic referral center. Methods CI patient charts from 2012 to 2021 were reviewed from a single pediatric hospital system to determine if monopolar cautery was used during a subsequent surgical procedure. In addition, a systematic review of the literature was performed to identify additional, relevant patients. Postoperative CI function was the primary outcome measure. Results In total, 190 patients underwent a surgical procedure following cochlear implantation in a single pediatric hospital system. Fifteen patients (7.9%) and 17 distinct surgical procedures were identified in which monopolar cautery was used. Seven of these 17 cases (41.2%) involved the head and neck, and 10 were performed below the clavicles. No patients experienced a device failure or a decline in CI performance following surgery. A systematic review identified an additional 4 patients who underwent a surgery that used monopolar cautery following cochlear implantation, and no change in CI function was identified. Conclusions The present study adds additional support to the notion that monopolar cautery does not necessarily injure CI functionality. While the most risk adverse strategy when planning a surgical procedure for a CI patient is to avoid monopolar cautery use altogether, the use of cautery should not immediately be associated with implant dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Monopolar Cautery Use in Pediatric Cochlear Implant Users

Page

Chapel

Silva

et al. 2022

Otolaryngol.--head neck surg.

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“…Since there are no sufficient safety data regarding rTMS for subjects with implanted electronic devices, the contraindication comprises implantations of the cochlear implant, pacemakers, implantable cardioverter defibrillators and spinal cord stimulators. However, a study reported that rTMS seemed to be safe for implanted electronic devices as long as the internal pulse generator was not close to the rTMS coil [ 40 ]. Moreover, it is relatively safe for the application of rTMS in patients with newly implanted electronic devices compatible with magnetic resonance imaging, although further large-scaled studies are warranted for long-term follow-up.…”

Section: Contraindications To Rtms Applicationmentioning

confidence: 99%

“…Implanted electronic device: cochlear implants [ 40 ], vagus nerve stimulators [ 42 ], pacemakers or implantable cardioverter defibrillators and spinal cord stimulators…”

Section: Figurementioning

confidence: 99%

Application of Repetitive Transcranial Magnetic Stimulation in Neuropathic Pain: A Narrative Review

Tsai

Han

et al. 2023

Life

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Neuropathic pain, affecting 6.9–10% of the general population, has a negative impact on patients’ quality of life and potentially leads to functional impairment and disability. Repetitive transcranial magnetic stimulation (rTMS)—a safe, indirect and non-invasive technique—has been increasingly applied for treating neuropathic pain. The mechanism underlying rTMS is not yet well understood, and the analgesic effects of rTMS have been inconsistent with respect to different settings/parameters, causing insufficient evidence to determine its efficacy in patients with neuropathic pain. This narrative review aimed to provide an up-to-date overview of rTMS for treating neuropathic pain as well as to summarize the treatment protocols and related adverse effects from existing clinical trials. Current evidence supports the use of 10 Hz HF-rTMS of the primary motor cortex to reduce neuropathic pain, especially in patients with spinal cord injury, diabetic neuropathy and post-herpetic neuralgia. However, the lack of standardized protocols impedes the universal use of rTMS for neuropathic pain. rTMS was hypothesized to achieve analgesic effects by upregulating the pain threshold, inhibiting pain impulse, modulating the brain cortex, altering imbalanced functional connectivity, regulating neurotrophin and increasing endogenous opioid and anti-inflammatory cytokines. Further studies are warranted to explore the differences in the parameters/settings of rTMS for treating neuropathic pain due to different disease types.

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“…Currently, cochlear implant (CI) manufacturers and the United States Food and Drug Administration caution against the use of ECT in CI users due to concern for thermal injury or device damage via electrical conduction. However, there is a paucity of data to assess the degree of caution required 1 …”

Section: Introductionmentioning

confidence: 99%

Preserved Cochlear Implant Function After Multiple Electroconvulsive Therapy Treatments

Jiam

Kramer

et al. 2020

The Laryngoscope

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This case report presents the successful use of multiple treatments of electroconvulsive therapy (ECT) in a patient with a cochlear implant (CI). A 60‐year‐old man with a left‐sided CI and bipolar disorder presented with severe depression. A total of 9 separate sessions of unilateral ECT was administered to the contralateral side of the existing CI. We collected subjective, clinical, and audiological assessment of the patient and the CI prior, during, and after ECT therapy. The patient tolerated ECT well and there were no complications. Unilateral ECT was performed contralateral to the CI without any harm to the patient or implant. Laryngoscope, 131:E1695–E1698, 2021

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Cochlear implant should not be absolute contraindication for electroconvulsive therapy and transcranial magnetic stimulation

Cited by 6 publications

References 9 publications

Monopolar Cautery Use in Pediatric Cochlear Implant Users

Monopolar Cautery Use in Pediatric Cochlear Implant Users

Application of Repetitive Transcranial Magnetic Stimulation in Neuropathic Pain: A Narrative Review

Preserved Cochlear Implant Function After Multiple Electroconvulsive Therapy Treatments

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