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Tremor Other Hyperkinet Mov (N Y). 2017 Sep 21;7:493. doi: 10.7916/D8BR94MV. eCollection 2017.

Management of Elevated Therapeutic Impedances on Deep Brain Stimulation Leads.

Author information

1
Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, USA.
2
Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.
3
J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.

Abstract

CLINICAL VIGNETTE:

A 64-year-old male with a history of essential tremor with bilateral thalamic ventralis intermedius deep brain stimulation implants had elevated therapeutic impedance values despite normal lead integrity impedances and good response to stimulation.

CLINICAL DILEMMA:

Do elevated therapeutic impedance values indicate a sign of hardware malfunction? What are the guidelines to approach deep brain stimulation hardware malfunction?

CLINICAL SOLUTION:

Lead integrity impedance values are a better evaluation of hardware integrity. The discrepancy between therapeutic and lead-integrity impedance values can arise when using low voltage settings.

GAPS IN KNOWLEDGE:

There are no established guidelines for the management of possible hardware malfunction in deep brain stimulation. The recommended approach is to distinguish between open and short circuit problems followed by an "inching" evaluation, assessing the structures from the implantable and programmable generator to the intracranial leads. Constant-current devices will deliver a more stable stimulation but the effect of their adoption is still not clear.

EXPERT COMMENTARY:

This case emphasizes the need for clinicians to understand fundamental differences in lead integrity and therapeutic impedance while utilizing a methodical approach in treating hardware malfunction. It highlights future avenues of investigation regarding the utility of constant current DBS technology.

KEYWORDS:

Therapeutic impedance; constant current; deep brain stimulation; lead integrity impedance; open circuit; short circuit

PMID:
28983423
PMCID:
PMC5628334
DOI:
10.7916/D8BR94MV
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Funding: None. Conflict of Interests: The authors report no conflict of interest. Ethics Statement: This study was reviewed by the authors’ institutional ethics committee and was considered exempted from further review.

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