Imaging of deep brain stimulation leads using extended Hounsfield unit CT.

Department of Neurosurgery, University of Washington, Seattle, WA 98195, USA.
Stereotactic and Functional Neurosurgery (Impact Factor: 1.48). 04/2009; 87(3):155-60. DOI: 10.1159/000209296
Source: PubMed

ABSTRACT Deep brain stimulation (DBS) has become a routine therapy for Parkinson's disease. Standard CT imaging, often used to evaluate DBS electrodes in patients with limited benefit or significant side effects, has limitations including inability to distinguish different metallic components of the DBS lead. CT imaging with an extended Hounsfield unit (EHU) scale allows advanced image processing techniques to detect individual electrodes. EHU-CT may be co-registered to MRI volumes to provide accurate anatomical visualization of DBS lead contacts.

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    ABSTRACT: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) in particular is highly effective in relieving symptoms of Parkinson's disease (PD). However, it can also have marked psychiatric side effects, including delirium, mania, and psychosis. The etiologies of those effects are not well-understood, and both surgeons and consulting psychiatrists are in need of treatment strategies. Two patients with young onset of PD and without significant prior psychiatric problems presented for bilateral STN DBS when medications became ineffective. Both had uneventful operative courses but developed florid psychosis 1-2 weeks later, before stimulator activation. Neither showed signs of delirium, but both required hospitalization, and one required treatment with a first-generation antipsychotic drug. Use of that drug did not worsen PD symptoms, contrary to usual expectations. These cases describe a previously unreported post-DBS syndrome in which local tissue reaction to lead implantation produces psychosis even without electrical stimulation of subcortical circuits. The lesion effect also appears to have anti-Parkinsonian effects that may allow the safe use of otherwise contraindicated medications. These cases have implications for management of PD DBS patients postoperatively, and may also be relevant as DBS is further used in other brain regions to treat behavioral disorders.
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May 23, 2014