Treatment for any movement disorder disease does not only involve medication and surgery. It also includes diet, exercise, support of family and friends and a healthy attitude. Patients should be advised to have positive and hopeful attitude, do regular exercise, yoga and meditation to improve the quality of life and decrease depression and anxious moods.
They should also be advised to have a normal healthy diet which promotes overall well-being of the patients. They should also be told that eating fiber-rich diet and drinking plenty of fluids also can help alleviate constipation. Connecting with other people who are supportive can be very helpful in coping. Support groups offer a safe place to talk about your feelings, questions and concerns and to get valuable information.
Deep Brain Stimulation surgery gives the patients and their family a better quality of life and enables them to do things they would not otherwise be able to do.
The patients with Intermittent Pulse Generator (IPG) battery inside the body should take following precautions during their lifetime:
There is a possibility of EMI – Electromagnetic Interference with following devices and equipment’s, so their use should be avoided:
- Commercial electrical equipment’s e.g. Arc welders
- Induction furnaces, Resistant welders
- Communication equipment’s e.g. microwave transmitters, power amplifiers,
- High-power amateur transmitters
- High voltage power lines
- Theft detectors and screening devices
Other sources of EMI in the home or occupational environment unlikely to interfere with Neurostimulator operation include the following:
- Home appliances that are properly grounded and in good working order.
- Cellular phones – It is recommended that it should not be kept in the pocket of the shirt over the area of pacemaker.
Electrical or fire cremation should not be performed with the IPG in-situ. It may produce an explosion. IPG should be removed and safely disposed off. (Return all explanted components to Medtronic for analysis and safe disposal.)
Diathermy should not be used e.g. surgical diathermy, diathermy used for dental procedure etc. If it is absolutely necessary to use the diathermy then only bipolar diathermy should be used.
The neurostimulator system may affect the operation of other implanted devices, such as cardiac pacemakers and implantable defibrillators. Possible effects include sensing problems and inappropriate devices responses. If the patient requires concurrent implantable pacemaker and/or defibrillator therapy, careful programming of each system may be necessary to optimize the patient’s benefit from each device.
It can also interfere with ECG tracing. Repositioning the ECG leads away from the pacemaker can rectify this interference. External defibrillation may damage a Neurostimulator. If external defibrillation is necessary and the situation permits, follow these precautions to minimize current flowing through the neurostimulator and lead-extension system:
- Position defibrillation paddles as far from the neurostimulator as possible.
- Position defibrillation paddles perpendicular to the implanted neurostimulator-lead system.
- Use the lowest clinically appropriate energy output (watt seconds).
- Confirm neuro-stimulation system function following any external defibrillation.
- Proper shielding of the device should be done so as to exclude it from the field of radiation
The ultrasonic devices like Electrohydraulic Lithotripter should not be used. If the use is mandatory; the beam should not be focused near the stimulator.
Patients with an implanted device should not be exposed to the electromagnetic fields produced by magnetic resonance imaging (MRI). Use of MRI may potentially change the neurostimulator settings, activate the device, or induce voltages in the neurostimulator and/or lead. An induced voltage through the neurostimulator or lead may cause uncomfortable, “jolting,” or “shocking” levels of stimulation. Additionally, MRI may dislodge or heat the lead. Any of the above effects may potentially injure the patient. Patients exposed to the electromagnetic fields generated from an MRI should be closely monitored, and programmed parameters verified upon cessation of MRI. However, recent study by Tronnier et al., 1999 on the effects of MRI on IPG has shown that there was no significant heat induction due to MRI.
MRI Guidelines for Pacemaker: Medtronic & Vercise (Boston Scientific)
Usually MRI is contraindicated in the patients with neuro-stimulators. However, in case there is a need for MRI, Medtronic has issued the following guidelines for performing MRI in patients with neurostimulator.
Different devices interact differently with the neuro-stimulators. Details of each device and its interaction with various groups of neuro-stimulators can be found here.
These guidelines are only for information the requirements for different pacemakers are different; before proceeding for MRI you should check with your Doctor.
Detailed guidelines for each individual device
Vercise™ Indications, Safety, and Warnings (DBS)
The Vercise™ Deep Brain Stimulation (DBS) Systems are indicated for use in unilateral or bilateral stimulation of the subthalamic nucleus (STN) or internal globus pallidus (GPi) for treatment of levodopa-responsive Parkinson’s disease which is not adequately controlled with medication and also for treatment of intractable primary and secondary Dystonia, for persons 7 years of age and older. Thalamic stimulation using the Boston Scientific Vercise™ DBS System is indicated for the suppression of tremor not adequately controlled by medications in patients diagnosed with Essential Tremor or Parkinson’s disease.
Vercise DBS Lead-only system (before Stimulator is implanted) and the Vercise Gevia™ systems are MR conditional. An MRI examination can be conducted safely when all instructions in the supplemental manual MRI Guidelines for Boston Scientific DBS Systems are followed.
CAUTION: The law restricts these devices to sale by or on the order of a physician. Vercise DBS Systems indications, contraindications, warnings and instructions for use can be found in the product labeling supplied with each device. Information for the use only in countries with applicable health authority registrations. Material not intended for use in France.
The Vercise M8 Adaptor is a 1 x 8 in-line connector that is designed to connect specific Medtronic® lead extensions to the Boston Scientific DBS System Stimulator, as part of a deep brain stimulation procedure.
Vercise™ and Vercise Gevia™ are registered trademarks of Boston Scientific Corporation or its affiliates. All cited trademarks are the property of their respective owners.
Products shown for INFORMATION purposes only and may not be approved for sale in certain countries. Please check availability with your local sales representative or customer service.