Electroconvulsive therapy in the presence of deep brain stimulation implants: electric field effects.

Journal Article (Journal Article)

The safety of electroconvulsive therapy (ECT) in patients who have deep brain stimulation (DBS) implants represents a significant clinical issue. A major safety concern is the presence of burr holes and electrode anchoring devices in the skull, which may alter the induced electric field distribution in the brain. We simulated the electric field using finite-element method in a five-shell spherical head model. Three DBS electrode anchoring techniques were modeled, including ring/cap, microplate, and burr-hole cover. ECT was modeled with bilateral (BL), right unilateral (RUL), and bifrontal (BF) electrode placements and with clinically-used stimulus current amplitude. We compared electric field strength and focality among the DBS implantation techniques and ECT electrode configurations. The simulation results show an increase in the electric field strength in the brain due to conduction through the burr holes, especially when the burr holes are not fitted with nonconductive caps. For typical burr hole placement for subthalamic nucleus DBS, the effect on the electric field strength and focality is strongest for BF ECT, which runs contrary to the belief that more anterior ECT electrode placements are safer in patients with DBS implants.

Duke Authors

Cited Authors

  • Deng, ZD; Hardesty, DE; Lisanby, SH; Peterchev, AV

Published Date

  • December 1, 2010

Published In

Start / End Page

  • 2049 - 2052

International Standard Serial Number (ISSN)

  • 1557-170X

Citation Source

  • Scopus