Management of Elevated Therapeutic Impedances on Deep Brain Stimulation Leads.
Management of Elevated Therapeutic Impedances on Deep Brain Stimulation Leads.
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DOI：
10.7916/d8br94mv
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Gunduz A
中科院分区：
文献类型：
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作者：
Deeb W;Patel A;Okun MS;Gunduz A
，男，有特发性震颤病史，植入双侧丘脑中脑腹侧深部电刺激，尽管导联完整性阻抗正常，刺激反应良好，但治疗阻抗值升高。治疗阻抗值升高是否表明硬件故障？处理脑深部刺激硬件故障的指导方针是什么？引线完整性阻抗值是硬件完整性的更好评估。使用低电压设置时，治疗性阻抗和导线完整性阻抗值之间可能会出现差异。对于脑深部刺激中可能出现的硬件故障的处理，目前还没有既定的指导方针。推荐的方法是区分开路和短路问题，然后进行“缓慢”评估，评估从植入式和可编程发电机到颅内导联的结构。恒流装置将提供更稳定的刺激，但采用它们的效果仍不清楚。此病例强调了临床医生需要了解导联完整性和治疗阻抗的根本差异，同时利用有条不紊的方法治疗硬件故障。它强调了关于恒流DBS技术的效用的未来调查途径。
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. Do elevated therapeutic impedance values indicate a sign of hardware malfunction? What are the guidelines to approach deep brain stimulation hardware malfunction? 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. 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. 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.