Category: Surgical Therapy: Parkinson's Disease
Objective: To report outcomes regarding deep brain stimulation (DBS) hardware integrity and preservation of program settings in a Parkinson’s Disease (PD) patient with bilateral globus pallidus internus (GPi) DBS who underwent external cardioversion.
Background: Case reports in the literature suggest that patients with DBS can safely receive implantable cardioverter-defibrillator (ICD) shocks without significant effect on DBS function and vice versa. Just one published case reported resetting of the DBS device after ICD deployment. Nevertheless, there remains a paucity of literature regarding the effects of external cardiac defibrillation on DBS. According to DBS device manufacturer specifications, external defibrillation can cause damage to either the neurostimulator or to brain tissue itself. To mitigate risks of defibrillation, paddles should be maximally distanced, applied perpendicularly to the DBS system, and the lowest necessary current should be used. To our knowledge, there are only three case reports describing patients with DBS who underwent external defibrillation. In all cases, patients had internal pulse generators (IPGs) in the anterior chest wall. All three patients developed either IPG failure, electrode dysfunction, or brain tissue damage.
Method: Case report and literature review
Results: A 72-year-old woman with PD and bilateral GPi DBS programmed in bipolar mode and with IPG in the right abdomen suffered a witnessed cardiac arrest, requiring external defibrillation. After three rounds of cardiopulmonary resuscitation and deliverance of one shock, she achieved return of spontaneous circulation. One week after cardioversion, the patient’s DBS device was interrogated. There were no difficulties in IPG communication, indication of hardware compromise, or disruption of programming settings. Although no evidence of brain tissue damage was found on CT or MRI, clinical assessment for ongoing stimulation benefit was not possible due to patient’s decline and eventual death due to medical complications.
Conclusion: External defibrillation is often emergently indicated in cardiac arrest, yet there is limited understanding of its effect on hardware and software integrity in patients with DBS. In this case report, we describe a unique scenario of a patient with a DBS IPG placed in the abdomen – a location removed from standard defibrillator pad placement – whose DBS system was not affected by external defibrillation.
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To cite this abstract in AMA style:J. Sadasivan, J. Wong, T. Stiep, A. Patterson, L. Almeida. Successful external defibrillation in a patient with bilateral deep brain stimulation [abstract]. Mov Disord. 2021; 36 (suppl 1). https://www.mdsabstracts.org/abstract/successful-external-defibrillation-in-a-patient-with-bilateral-deep-brain-stimulation/. Accessed December 1, 2023.
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