Permanent Neurological Deficit Related to Magnetic Resonance Imaging in a Patient with Implanted Deep Brain Stimulation Electrodes for Parkinson's Disease: Case Report

Henderson, Jaimie M.; Tkach, Jean A.; Phillips, Michael; Baker, Kenneth B.; Shellock, Frank G.; Rezai, Ali R.

doi:10.1227/01.neu.0000180810.16964.3e

Cited by 266 publications

(221 citation statements)

References 4 publications

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“…78,79 The principal manufacturer of DBS systems states that MR imaging is contraindicated in patients with DBS unless specific precautions are taken. If these precautions are taken, MR imaging can and has been performed in many cases safely, but the patient and physician must be aware of the potential MR imaging hazards.…”

mentioning

confidence: 99%

Neuroimaging and Deep Brain Stimulation

Dormont¹,

Seidenwurm²,

Galanaud³

et al. 2009

AJNR Am J Neuroradiol

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SUMMARY: Deep brain stimulation (DBS) is a new neurosurgical method principally used for the treatment of Parkinson disease (PD).Many new applications of DBS are under development, including the treatment of intractable psychiatric diseases. Brain imaging is used for the selection of patients for DBS, to localize the target nucleus, to detect complications, and to evaluate the final electrode contact position. In patients with implanted DBS systems, there is a risk of electrode heating when MR imaging is performed. This contraindicates MR imaging unless specific precautions are taken. Involvement of neuroradiologists in DBS procedures is essential to optimize presurgical evaluation, targeting, and postoperative anatomic results. The precision of the neuroradiologic correlation with anatomic data and clinical outcomes in DBS promises to yield significant basic science and clinical advances in the future. Chronic high-frequency stimulation of the ventral intermediate nucleus (VIM) of the thalamus was first described in the early 1990s by Benabid et al.1 These authors implanted chronic stimulating electrodes in the VIM connected to a subcutaneous pulse generator positioned in the thoracic region to treat disabling tremor in 26 patients with Parkinson disease (PD) and in 6 with essential tremor.1 They demonstrated the effectiveness of this technique and its ability to produce complete relief from tremor. Improvement was maintained for up to 29 months. This was the first clinical demonstration that chronic high-frequency stimulation of nuclei (deep brain stimulation [DBS]) could replace destructive lesion-producing functional neurosurgery such as thalamotomy. This new technique was reversible and led to a renaissance in functional neurosurgery.Next, the same team introduced bilateral DBS of the subthalamic nucleus (STN) in patients with disabling akineticrigid PD and severe motor fluctuations.2 This work extended data obtained in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine monkey model of PD showing that lesions and electric stimulation of the subthalamic nucleus reduced all of the major motor disturbances in this animal model. The results in patients with advanced PD were striking and were reproduced in many centers internationally. The US Food and Drug Administration approved the use of DBS for treatment of advanced PD with bilateral STN stimulation in 2002 and internal globus pallidus (GPi) stimulation in 2003. The main indication for DBS remains advanced PD, but numerous additional applications have been developed, ranging from dystonia to cluster headache, Tourette syndrome, and even psychiatric indications like obsessive-compulsive disorders (OCD) and major depression.DBS is a neurosurgical method, but the role of neuroimaging in successful DBS intervention is critical. Neuroimaging is used for the preoperative selection of patients who will have DBS and to localize the intended target nuclei. In the postoperative period, imaging detects complications that uncommonly accompany the procedure, confirms the pos...

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mentioning

confidence: 99%

Neuroimaging and Deep Brain Stimulation

Dormont¹,

Seidenwurm²,

Galanaud³

et al. 2009

AJNR Am J Neuroradiol

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“…The safety of the MRI scan is another issue with those who were keeping DBS electrodes in their brains 13,22,36) . In 2000, Yamamoto et al first reported a case of thalamic lesioning in a patient treated with a thalamic DBS after emergent cardioversion for the treatment of severe arrhythmia of the patient 36) .…”

Section: Discussionmentioning

confidence: 99%

“…In 2000, Yamamoto et al first reported a case of thalamic lesioning in a patient treated with a thalamic DBS after emergent cardioversion for the treatment of severe arrhythmia of the patient 36) . In 2005, Henderson et al described a case of serious, permanent neurological injury secondary to a radiofrequency lesion produced by the heating of a DBS electrode associated with the MR image scanning of the lumbar spine in a patient with PD 13) . With those anec-dotal occurrences of severe adverse effects related with DBS in the brains, the FDA issued a warning about the possible significant side effects when brain MRIs were performed on patients with a DBS in their brain.…”

Section: Discussionmentioning

confidence: 99%

STN DBS of Advanced Parkinson's Disease Experienced in a Specialized Monitoring Unit with a Prospective Protocol

Lee

Han

Kim

et al. 2008

J Korean Neurosurg Soc

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“…The risk of severe injury with the lead inserted into the brain when a 1.5-T MRI scan is performed has been already reported but has to be counterbalanced with the large number of patients in whom MRI scans, using head coils, have been performed also without any problems [4,6,16,25]. While some isolated MR complications occurred in implanted patients, with the need to modify safety rules [7,9,21], many teams reported accuracy, innocuousness, and advantages of its use.…”

Section: Feasibility and Technical Requirementmentioning

confidence: 99%

Surgical implantation of STN-DBS leads using intraoperative MRI guidance: technique, accuracy, and clinical benefit at 1-year follow-up

et al. 2015

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Background Improvement of surgical accuracy during DBSlead implantation has been described recently, leading to Bframeless^or BMRI-verifiedB techniques. However, combining a high-quality definition of the STN using intraoperative 1.5 MRI with the possibility to reduce errors due to coregistration and to monitor lead progression during surgical insertion while checking the absence of surgical complication is an appealing method. We report here surgical methodology, safety, application accuracy, and clinical benefit of STN-lead implantation under MRI guidance. Methods Two patients with a severe PD state were treated by bilateral STN-DBS. Leads were implanted under general anesthesia using intraoperative MRI guidance (ClearPoint system). Lead implantation accuracy was measured on T1 axial images at the level of the target. Clinical improvement was measured on the pre-and post-UPDRS 3 scale at 1-year follow-up. Results Surgery was safe and uneventful in both cases. Radial error was 0.36 (right) and 0.86 mm (left) in case 1, and 0.41 (right) and 0.14 mm (left) in case 2. No edema or hemorrhage were noticed. Conclusions Intraoperative MRI guidance allows DBS lead implantation with high accuracy and with great clinical efficacy. A larger cohort of patients is needed to confirm these initial results.

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Permanent Neurological Deficit Related to Magnetic Resonance Imaging in a Patient with Implanted Deep Brain Stimulation Electrodes for Parkinson's Disease: Case Report

Abstract: To prevent catastrophic incidents, the manufacturer's guidelines should be followed carefully because they are known to result in the safe performance of MRI examinations of patients with neurostimulation systems used for DBS.

Cited by 266 publications

References 4 publications

Neuroimaging and Deep Brain Stimulation

Neuroimaging and Deep Brain Stimulation

STN DBS of Advanced Parkinson's Disease Experienced in a Specialized Monitoring Unit with a Prospective Protocol

Surgical implantation of STN-DBS leads using intraoperative MRI guidance: technique, accuracy, and clinical benefit at 1-year follow-up

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