Letter to editor in response to De vloo et al.: Open fracture of DBS leads with normal electrical impedance
Notice bibliographique
Résumé
We here add a similar case to the report by Drs. DeVloo, Vermeulen, Vandenberghe and Nuttin [[1]DeVloo P. Vermeulen L. Vandenberghe W. Nuttin B. Open fracture of deep brain stimulation leads with normal electrical impedances.Brain Stim. 2020; 13: 1639-1641https://doi.org/10.1016/j.brs.2020.09.018Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar], describing a patient with intact impedance measures despite an internal breakage of a deep brain stimulator (DBS) extension. Our male patient underwent subthalamic (STN) DBS for advanced Parkinson’s disease (PD) in 2004 at the age of 48 (3389 leads connected to two 7482A-51 extensions, Kinetra, Medtronic Inc, Minneapolis MN). He underwent several pulse generator replacements (later in 2004 after a lightning strike, then for battery depletions in 2009, 2014, and with a rechargeable Activa RC in 2017). His PD progressed, especially in his right body with significant dystonia in his hand, requiring joint fusions. His gait was most affected, but he was able to ambulate around his home with a walker. He had difficulty tolerating PD medications due to dyskinesia, but started taking 4 tablets of levodopa/benserazide (50/12.5 mg) daily in 2018 in addition to amantadine for symptom management. In 2020 at the age of 64, he developed shocks in his head/neck, both spontaneously and sometimes with neck movements. Impedances of all DBS leads were completely normal and unchanged from measurements obtained at previous annual check-ups. Notably, the impedances were different in the right and left leads (Fig. 1A), and remained the same with his head turned to different positions. Skull and neck radiography revealed an apparent wire disconnection in the left DBS extension (Fig. 1B). While he had not had skull radiography since his original surgery, chest radiography showing the extension coming down from the neck to the pulse generator indicated that this breakage was present for at least one year prior (Fig. 1C). Based on his clinical picture we wondered how long this may have been an issue, but not identified due to normal impedance measures. The patient underwent revision of his extension and intra-operative findings showed a physically intact extension cable with the wiring within the extension being pale and seemingly having lost its coil (Fig. 1D). Post-operative course was marked by worsening of gait, such that he required gradual adjustment in stimulation parameters, medications, and botulinum toxin injections over 2 weeks in hospital, to regain his ability to walk with a walker. It is not clear how normal impedances could be measured using the clinician programmer (N’Vision Clinician Programmer model 8840 and CT900D Clinician tablet) with such apparent wire disconnection. Possibly the intact external insulation of the silastic cover of the extension could allow these measurements to be obtained. Regardless, it is a concerning problem with long term DBS. This case further emphasizes the need to use radiography to check connections in advanced PD patients, especially those having falls, even with normal impedance measurements. No specific funding for this case report.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».