Bilateral Deep Brain Stimulator Implantation in Two Parkinson's Disease Patients with Preexisting Cardiac Pacemakers

 

Patrick B. Senatus, MD, PhD

Shearwood McClelland III, AB

Anjanette D. Ferris, MD

Blair Ford, MD, FRCPC

Linda M. Winfield, RN, MPH

Seth L. Pullman, MD, FRCPC

Qiping Yu, PhD

Guy M. McKhann II, MD

Stanley J. Schneller, MD

Robert R. Goodman, MD, PhD

 

Departments of Neurological Surgery, Neurology, and Cardiology, Columbia University College of Physicians and Surgeons, New York, New York

 

Introduction:

Implantation of deep brain electrodes has become a standard tool for surgical therapy of Parkinson's disease (PD). In patients with comorbid arrhythmias requiring cardiac pacemakers, it has been thought that deep brain stimulation (DBS) is relatively contraindicated due to the theoretical risk of electrical interference between the cardiac pacemaker and the brain stimulator current.

 

Methods:

We report two cases of patients with preexisting cardiac pacemakers who were successfully implanted bilaterally with DBS electrodes in the subthalamic nucleus (STN) for medically refractory PD. Both patients underwent CT-guided stereotactic planning (by Stealth FrameLink 4.0 software) and microelectrode recording-guided DBS electrode placement. The cranial pulse generators were placed subcutaneously in the left and right abdomen. Both extension wires were passed on the right side of the head and neck contralateral to the pacemaker side using long extension wires, to enable battery placement in the abdomen.

 

Results:

Postoperative management involved brain stimulator programming sessions with simultaneous cardiology monitoring of pacemaker function and cardiac rhythm. No interference was noted at any time, and proper pacemaker function was maintained throughout follow-up. Concomitantly, both patients experienced dramatic improvement of their PD symptoms, including elimination of dyskinesias, reduction of "off" severity, and increase of "on" duration.

 

Conclusion:

With some modifications of implant strategy, two patients with a cardiac pacemaker were successfully treated with bilateral DBS STN therapy for refractory PD. To our knowledge, these are the first reports of patients with a cardiac pacemaker undergoing brain stimulator implantation.