Variation in Deep Brain Stimulation Electrode Impedance over Years Following Electrode Implantation

Satzer, David; Lanctin, David; Eberly, Lynn E.; Abosch, Aviva

doi:10.1159/000358014

Cited by 83 publications

(94 citation statements)

References 38 publications

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“…As in past studies,21 22 impedance was found to vary by contact position along the DBS electrode, with mean impedance highest in contact 0 and lowest in contact 2, at baseline (ie, during initial programming, typically 3 weeks following electrode implantation) and over time. Impedance has also been found to decrease over time and with contact activity21 22; this result was verified in the present study.…”

Section: Discussionsupporting

confidence: 73%

“…Quadripolar DBS electrode contacts are numbered 0–3, from caudal to rostral-most. Two studies of impedance over time since implantation found that impedance was highest in contact 0 and lowest in contact 2 21 22. Assuming relatively consistent electrode placement with respect to STN, contact number is likely to correlate with anatomic location.…”

Section: Introductionmentioning

confidence: 99%

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Anatomic correlates of deep brain stimulation electrode impedance

Satzer

Maurer

Lanctin

et al. 2014

J Neurol Neurosurg Psychiatry

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Anatomic correlates of deep brain stimulation electrode impedance

Satzer

Maurer

Lanctin

et al. 2014

J Neurol Neurosurg Psychiatry

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“…Previous publications have reported transient increases in impedance in depth and subdural electrodes followed by a decrease after the acute phase of the tissue reaction has passed in animals and in a large clinical trial [1,6,10,12,16,17]. We have previously reported "… a trend for impedance to increase over the first 12 weeks after implant.…”

Section: Discussionmentioning

confidence: 70%

Long-Term Surface Electrode Impedance Recordings Associated with Gliosis for a Closed-Loop Neurostimulation Device

Sillay

Ondoma

Wingeier³

et al. 2018

Ann Neurosci

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Background: Closed-loop neurostimulation is a novel alternative therapy for medically intractable focal epilepsy for patients who are not candidates for surgical resection of a seizure focus. Electrodes for this system can be implanted either within the brain parenchyma or in the subdural space. The electrodes then serve the dual role of detecting seizures and delivering an electrical signal aimed at aborting seizure activity. The Responsive Neurostimulation (RNS®) system (Neuropace, Mountain View, CA, USA) is an FDA-approved implantable device designed for this purpose. Objective: One of the challenges of the brain machine interface devices is the potential for implanted neurostimulator devices to induce progressive gliosis, apart from that associated with the minimal trauma at implantation. Gliosis has the potential to alter impedances over time, thereby affecting the clinical efficacy of these devices, and also poses a challenge to the prospects of in vivo repositioning of depth electrodes. We present a clinical case with 3-year follow-up and pathology. Methods: Single-case, retrospective review within a randomized trial with specific minimum follow-up and impedance measurements. Results: Impedance changes in the surface electrode over time were observed. Surgical pathological findings revealed significant gliosis in the leptomeninges of the cortices. Conclusion: We report, for the first time, long-term impedance recordings from a surface electrode associated with pathologic findings of gliosis at the Neuropace device-tissue interface in a patient who was enrolled in the multicenter RNS System Pivotal Clinical Investigation. Further study is required to elucidate the temporal relationship of pathological findings over time. Impedance changes were more complex than can be explained by a progressive or transient pathological mechanism. Further effort is required to elucidate the relationship between impedance change and seizure event capture.

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“…Our study was designed to address the unresolved question of whether the modality of delivery of electrical charge in any way alters the clinical benefit or side effects of stimulation. To control for impedance changes, this study was conducted 2 years after surgery, when the chronic impedance values are thought to be established [14,15]. Thus, the clinical effects of differing stimulus waveform could be studied in isolation.…”

Section: Introductionmentioning

confidence: 99%

Constant Current versus Constant Voltage Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease

Noriega

Eitan²,

Marmor³

et al. 2015

Stereotact Funct Neurosurg

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Background: Subthalamic nucleus (STN) deep brain stimulation (DBS) is an established therapy for advanced Parkinson's disease (PD). Motor efficacy and safety have been established for constant voltage (CV) devices and more recently for constant current (CC) devices. CC devices adjust output voltage to provide CC stimulation irrespective of impedance fluctuation, while the current applied by CV stimulation depends on the impedance that may change over time. No study has directly compared the clinical effects of these two stimulation modalities. Objective: To compare the safety and clinical impact of CC STN DBS to CV STN DBS in patients with advanced PD 2 years after surgery. Methods: Patients were eligible for inclusion if they had undergone STN DBS surgery for idiopathic PD, had been implanted with a Medtronic Activa PC and if their stimulation program and medication had been stable for at least 1 year. This single-center trial was designed as a double-blind, randomized, prospective study with crossover after 2 weeks. Motor equivalence of the 2 modalities was confirmed utilizing part III of the Unified Parkinson's Disease Rating Scale (UPDRS). PD diaries and multiple subjective and objective evaluations of quality of life, depression, cognition and emotional processing were evaluated on both CV and on CC stimulation. Analysis using the paired t test with Bonferroni correction for multiple comparisons was performed to identify any significant difference between the stimulation modalities. Results: 8 patients were recruited (6 men, 2 women); 1 patient did not complete the study. The average age at surgery was 56.7 years (range 47-63). Disease duration at the time of surgery was 7.5 years (range 3-12). Patients were recruited 23.8 months (range 22.5-24) after surgery. At the postoperative study baseline, this patient group showed an average motor improvement of 69% (range 51-97) as measured by the change in UPDRS part III with stimulation alone. Levodopa equivalent medication was reduced on average by 67% (range 15-88). Patients were poorly compliant with PD diaries, and these did not yield useful information. The minor deterioration in quality-of-life scores (Parkinson's Disease Questionnaire-39, Quality of Life Enjoyment and Satisfaction Questionnaire) with CC stimulation were not statistically significant. Two measures of depression (Hamilton Rating Scale D17, Quick Inventory of Depressive Symptomatology - Self-Report) showed a nonsignificant lower score (less depression) with CC stimulation, but a third (Beck Depression Inventory) showed equivalence. Cognitive testing (Mini Mental State Examination) and emotional processing (Montreal Affective Voices) were equivalent for CC and CV. Conclusion: CC STN DBS is safe. For equivalent motor efficacy, no significant difference could be identified between CC and CV stimulation for nonmotor evaluations in PD patients 2 years after surgery.

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Variation in Deep Brain Stimulation Electrode Impedance over Years Following Electrode Implantation

Cited by 83 publications

References 38 publications

Anatomic correlates of deep brain stimulation electrode impedance

Anatomic correlates of deep brain stimulation electrode impedance

Long-Term Surface Electrode Impedance Recordings Associated with Gliosis for a Closed-Loop Neurostimulation Device

Constant Current versus Constant Voltage Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease

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