Short circuit in deep brain stimulation.
Short circuit in deep brain stimulation.
复制标题
脑深部刺激发生短路。
DOI：
10.3171/2012.8.jns112073
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发表时间：
2012
影响因子：
4.1
通讯作者：
K. Kamikaseda
中科院分区：
文献类型：
--
作者：
K. Samura;Y. Miyagi;T. Okamoto;T. Hayami;J. Kishimoto;Mitsuo Katano;K. Kamikaseda
对象
作者开展了这项研究，以调查接受脑深部刺激(DBS)治疗的患者短路的发生率、原因和临床影响。
方法
在常规随访中偶然发现短路后，作者在他们的机构启动了一项政策，在每次DBS门诊随访时定期评估治疗阻抗和系统阻抗，而不管是否存在暗示可能的系统故障的症状。这项研究是他们在这项政策实施一年后的结果报告。
结果
在7名患者中发现植入的DBS导联显示短路(在12个月的研究期间进行门诊随访检查的患者中有8.9%)。从植入DBS导线到发现短路的平均时间为64.7个月。6例帕金森病(PD)患者出现疗效减退、眼睑张开失用或构音障碍等短路症状，1例全身性肌张力障碍患者出现肌张力障碍恶化。所有短路的DBS导联都已用钛微型钢板固定在头盖骨上。改变电极设置可改善2例帕金森病患者的临床症状(2.5%)，但另4例患者无明显短路症状。患有肌张力障碍的患者接受了重新定位和更换导联，因为先前的导联位置太靠前，但症状没有改善。
结论
与断路导致DBS突然失去临床疗效不同，由于阻抗逐渐降低，可能会出现短路，通过有限或延长的电位场导致潜伏的神经症状发展，以及缩短电池寿命。星展银行短路的发生率可能比之前认为的要高，特别是在星展银行导线用迷你板固定的情况下。DBS的电路阻抗应该常规检查，即使在DBS治疗了很长一段时间后，特别是在微型钢板锚定的情况下。
OBJECT
The authors undertook this study to investigate the incidence, cause, and clinical influence of short circuits in patients treated with deep brain stimulation (DBS).
METHODS
After the incidental identification of a short circuit during routine follow-up, the authors initiated a policy at their institution of routinely evaluating both therapeutic impedance and system impendence at every outpatient DBS follow-up visit, irrespective of the presence of symptoms suggesting possible system malfunction. This study represents a report of their findings after 1 year of this policy.
RESULTS
Implanted DBS leads exhibiting short circuits were identified in 7 patients (8.9% of the patients seen for outpatient follow-up examinations during the 12-month study period). The mean duration from DBS lead implantation to the discovery of the short circuit was 64.7 months. The symptoms revealing short circuits included the wearing off of therapeutic effect, apraxia of eyelid opening, or dysarthria in 6 patients with Parkinson disease (PD), and dystonia deterioration in 1 patient with generalized dystonia. All DBS leads with short circuits had been anchored to the cranium using titanium miniplates. Altering electrode settings resulted in clinical improvement in the 2 PD cases in which patients had specific symptoms of short circuits (2.5%) but not in the other 4 cases. The patient with dystonia underwent repositioning and replacement of a lead because the previous lead was located too anteriorly, but did not experience symptom improvement.
CONCLUSIONS
In contrast to the sudden loss of clinical efficacy of DBS caused by an open circuit, short circuits may arise due to a gradual decrease in impedance, causing the insidious development of neurological symptoms via limited or extended potential fields as well as shortened battery longevity. The incidence of short circuits in DBS may be higher than previously thought, especially in cases in which DBS leads are anchored with miniplates. The circuit impedance of DBS should be routinely checked, even after a long history of DBS therapy, especially in cases of miniplate anchoring.