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Diplopia associated with loop routing in deep brain stimulation: illustrative case.
Yasushi Miyagi1, Eiichirou Urasaki2
1Department of Stereotactic and Functional Neurosurgery and.
Journal of Neurosurgery. Case Lessons
|July 20, 2022
Summary
Loop-routed deep brain stimulation (DBS) circuits can cause visual side effects like diplopia. Adjusting stimulation settings, such as changing from unipolar to bipolar, can resolve these issues in patients with Parkinson's disease.
Area of Science:
- Neurosurgery
- Neurology
- Biomedical Engineering
Background:
- Deep brain stimulation (DBS) is a key treatment for drug-resistant movement disorders.
- External electromagnetic interference (EMI) poses a risk to implanted DBS devices.
Purpose of the Study:
- To investigate a case of transient diplopia following DBS IPG replacement with loop routing.
- To identify potential causes of visual side effects in DBS patients with specific IPG configurations.
Main Methods:
- A patient with Parkinson's disease underwent IPG replacement with a dual-channel IPG routed in a loop.
- DBS programming was initially maintained, leading to diplopia, and then adjusted to resolve symptoms.
Main Results:
- The patient experienced transient paroxysmal diplopia after IPG replacement with loop routing.
- Diplopia resolved upon changing the stimulation setting from unipolar to bipolar on one side.
- Two of four previous patients with loop routing experienced diplopia in an experimental unipolar setting.
Conclusions:
- Loop-routed DBS circuits may distort the stimulus field, independent of external EMI.
- Clinicians should consider stimulus field distortion from loop routing as a cause of side effects.
- Adjusting stimulation parameters (e.g., unipolar to bipolar) may mitigate visual disturbances.
