Skip to main content
Journal cover image

Investigation of deep brain stimulation mechanisms during implantable pulse generator replacement surgery.

Publication ,  Journal Article
Swan, BD; Grill, WM; Turner, DA
Published in: Neuromodulation
July 2014

BACKGROUND: Direct testing of deep brain stimulation (DBS) mechanisms in humans is needed to assess therapy and to understand stimulation effects. OBJECTIVE: We developed an innovative paradigm for investigation of DBS on human movement disorders. Temporary connection to the DBS electrode during implantable pulse generator (IPG) replacement permitted analysis of novel patterns of stimulation on motor symptoms, which could enhance efficacy and improve battery life. MATERIALS AND METHODS: Patients enrolled in this prospective, Institutional Review Board-approved study underwent IPG replacement using local (monitored) anesthesia. Following device explant, the DBS electrode was connected to an external, isolated electrical stimulator using a sterile adapter cable. Different temporal patterns of stimulation were delivered while quantifying upper-extremity tremor (tri-axial accelerometry) or bradykinesia (finger-tapping). Upon experiment completion, the new IPG was implanted. RESULTS: Among 159 IPG replacements from 2005 to 2011, 56 patients agreed to the research study (16 essential tremor [ET], 31 Parkinson's disease [PD], 5 mixed ET/PD tremor, 3 multiple sclerosis, 1 tremor/myoclonus). Surgical procedures were extended by 42 ± 8.2 min in 37 patients completing the study. Motor symptoms varied with stimulation pattern, with some patterns showing improved tremor or bradykinesia control. No postoperative infections or complications were observed in the 159 patients. CONCLUSION: IPG replacement occurs when the DBS/brain interface is stable and patients demonstrate symptom reduction with known stimulation parameters. Conducting research at this time point avoids DBS implant issues, including temporary microlesion effects, fluctuating electrode impedances, and technical limitations of contemporary IPGs, providing advantageous conditions to conduct translational DBS research with minimal additional risk to research subjects.

Duke Scholars

Published In

Neuromodulation

DOI

EISSN

1525-1403

Publication Date

July 2014

Volume

17

Issue

5

Start / End Page

419 / 424

Location

United States

Related Subject Headings

  • Tremor
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Movement Disorders
  • Male
  • Hypokinesia
  • Humans
  • Functional Laterality
  • Female
  • Electrodes, Implanted
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Swan, B. D., Grill, W. M., & Turner, D. A. (2014). Investigation of deep brain stimulation mechanisms during implantable pulse generator replacement surgery. Neuromodulation, 17(5), 419–424. https://doi.org/10.1111/ner.12123
Swan, Brandon D., Warren M. Grill, and Dennis A. Turner. “Investigation of deep brain stimulation mechanisms during implantable pulse generator replacement surgery.Neuromodulation 17, no. 5 (July 2014): 419–24. https://doi.org/10.1111/ner.12123.
Swan BD, Grill WM, Turner DA. Investigation of deep brain stimulation mechanisms during implantable pulse generator replacement surgery. Neuromodulation. 2014 Jul;17(5):419–24.
Swan, Brandon D., et al. “Investigation of deep brain stimulation mechanisms during implantable pulse generator replacement surgery.Neuromodulation, vol. 17, no. 5, July 2014, pp. 419–24. Pubmed, doi:10.1111/ner.12123.
Swan BD, Grill WM, Turner DA. Investigation of deep brain stimulation mechanisms during implantable pulse generator replacement surgery. Neuromodulation. 2014 Jul;17(5):419–424.
Journal cover image

Published In

Neuromodulation

DOI

EISSN

1525-1403

Publication Date

July 2014

Volume

17

Issue

5

Start / End Page

419 / 424

Location

United States

Related Subject Headings

  • Tremor
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Movement Disorders
  • Male
  • Hypokinesia
  • Humans
  • Functional Laterality
  • Female
  • Electrodes, Implanted