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Electroconvulsive therapy in the presence of deep brain stimulation implants: Electric field effects

机译:存在深部脑刺激植入物的电惊厥疗法:电场效应

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The safety of electroconvulsive therapy (ECT) in patients who have deep brain stimulation (DBS) implants represents a significant clinical issue. A major safety concern is the presence of burr holes and electrode anchoring devices in the skull, which may alter the induced electric field distribution in the brain. We simulated the electric field using finite-element method in a five-shell spherical head model. Three DBS electrode anchoring techniques were modeled, including ring/cap, microplate, and burr-hole cover. ECT was modeled with bilateral (BL), right unilateral (RUL), and bifrontal (BF) electrode placements and with clinically-used stimulus current amplitude. We compared electric field strength and focality among the DBS implantation techniques and ECT electrode configurations. The simulation results show an increase in the electric field strength in the brain due to conduction through the burr holes, especially when the burr holes are not fitted with nonconductive caps. For typical burr hole placement for subthalamic nucleus DBS, the effect on the electric field strength and focality is strongest for BF ECT, which runs contrary to the belief that more anterior ECT electrode placements are safer in patients with DBS implants.
机译:对于患有深部脑刺激(DBS)植入物的患者,电抽搐治疗(ECT)的安全性是一个重要的临床问题。一个主要的安全隐患是头骨中存在毛刺孔和电极锚固装置,这可能会改变大脑中感应电场的分布。我们在五壳球头模型中使用有限元方法模拟了电场。对三种DBS电极锚定技术进行了建模,包括环/帽,微孔板和毛孔覆盖。 ECT是用双侧(BL),右单侧(RUL)和双额(BF)电极放置以及临床使用的刺激电流幅度建模的。我们比较了DBS植入技术和ECT电极配置之间的电场强度和聚焦性。仿真结果表明,由于通过毛刺孔的传导,大脑中的电场强度增加了,特别是当毛刺孔未安装不导电帽时。对于丘脑丘脑底DBS的典型毛刺孔放置,BF ECT对电场强度和聚焦性的影响最大,这与认为DBS植入物患者更安全的ECT电极放置更安全的观点背道而驰。

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