Dos & Dont’s

1. Electrocautery– Particularly the monopolar cautery should not be used but if use is very necessary turn off the neurostimulator. Bipolar cautery use is recommended.

2. External defibrillation, its safe use in DBS patients has not been established.

• If its use is necessary, following precautions should be taken:

a. Position defibrillation paddles as far from the neurostimulator.

b. Position defibrillation peddles perpendicular to the implanted neurostimulation-lead system.

c. Use lowest clinically appropriate energy output (watt seconds).

Confirm neurostimulation system function following any external defibrillation

3. Lithotripsy – Use of high output an ultrasonic device, such as electrohydraulic lithotriptor, is not recommended for patients with implanted neurostimulation system.

• There will be no damage to the patient, but exposure to high output frequencies may result in damage to the circuits.

• If lithotripsy must be done, do not focus the beam near the neurostimulator.

4. Radiation Therapy– High radiation sources, such as cobalt-60 or gamma radiation, should not be directed at the neurostimulator.

• If patient requires radiation therapy, lead shielding should be used over the stimulator to prevent its damage. Any device damage due to radiation may not be immediately detectable.

5. MRI– Patients with Boston Vercise should not be subjected to MRI to avoid damage to device and patient. Now, MRI compatible Boston IPG are available .

• Activa-PC and Activa-RC IPG are compatible with 1.5 T MRI once the device is swiched OFF (stimulation should be 0 with bipolar lead settings), settings should be checked after the procedure .

MRI exposure may results in:

a. Dislodgement of implanted components.

b. Heating of contacts or other system components, causing permanent tissue lesioning.

c. Damage to stimulator’s electronics.

d. Current induction in DBS system may cause unpredictable levels of stimulation.

e. Distortion of the disgnostic image.

f. Personal injury or even death.

g. Patients exposed to electromagnetic fields should be closely monitored, and programmed parameters verified upon cessation of MRI.

h. CT scans are safe in these patients.

6. Diathermy– Shortwave, microwave and/or therapeutic ultrasound diathermy should not be used. Stimulator may be critically damaged by the diathermy use. Diagnostic ultrasonography are safe in these patients.

7. Transcranial stimulation– safe use of transcranial magnetic stimulation, have not been established with stimulators.

8. ECG– Neurostimulators interferes with ECG tracing. Repositioning the ECG leads away from the pacemaker can rectify this interference.

Even if artifacts are seen in ECG, IPG can be switched off for a while.

9. EEG – Neurostimulators interferes with EEG tracings. Repositioning of EEG leads away from the pacemaker can avoid the artifacts.

• Most routine diagnostic procedures such as, x-rays, fluoroscopy are not expected to affect the system operation.

10. Dental procedures

• Tell your dentist where your neurostimulator is implanted, so he or she can take

precautions with dental drills and ultrasonic probes used to clean your teeth.

• These devices should not be used directly over the implant site.

11. Effect on other medical devices, like cardiac pacemaker-

• Neurostimulation system may affect the operation of other implanted devices, such as cardiac pacemakers and implantable defibrillators.

• If patient requires concurrent implantable devices, careful programming of each system may be necessary to optimize benefit from each device.

12. Patients should not pass through the scanners used in Airport security or at the entrances of buildings including hand held scanners.

13. Patients should avoid arc welders, induction furnaces, microwave transmitters, power amplifiers, high voltage power lines, which may generate enough electromagnetic interference with neurostimulator.