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Increased electrode impedance as an indicator for early detection of deep brain stimulation (DBS) hardware Infection: Clinical experience and in vitro study. | LitMetric

Increased electrode impedance as an indicator for early detection of deep brain stimulation (DBS) hardware Infection: Clinical experience and in vitro study.

J Clin Neurosci

Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Harvard University, Boston, MA, United States.

Published: February 2024

AI Article Synopsis

  • A patient underwent deep brain stimulation (DBS) for dystonia and showed increased electrode impedance three months post-surgery, leading to the discovery of an infection that required hardware removal after six months.
  • Researchers recreated the infection conditions in a lab to measure electrical impedance changes over time when introducing Staphylococcus aureus, observing a 33.7% increase in impedance by day three.
  • The study suggests that monitoring impedance could help identify DBS infections early, and effective antibiotic treatment might lower the need for surgical removal of the hardware.

Article Abstract

Background: When deep brain stimulation (DBS) infections are identified, they are often too advanced to treat without complete hardware removal. New objective markers to promptly identify DBS infections are needed. We present a patient with GPi (globus pallidus interna) DBS for dystonia, where the electrode impedance unexpectedly increased 3-months post-operatively, followed by serologic and hematologic markers of inflammation at 6-months, prompting explantation surgery. We recreated these conditions in a laboratory environment to analyze the pattern of changing of electrical impedance across the contacts of a DBS lead following Staphylococcus biofilm formation.

Methods: A stainless-steel culture chamber containing 1 % brain heart infusion agar was used. A DBS electrode was dipped in peptone water containing a strain of S. aureus and subsequently introduced into the chamber. The apparatus was incubated at 37 °C for 6 days. Impedance was measured at 24hr intervals. A control experiment without S. Aureus inoculation was used to determine changes in impedance over a period of 6-days.

Results: The mean monopolar impedance on day-1 was 751.8 ± 23.8 Ω and on day-3 was 1004.8 ± 68.7 Ω, a 33.7 % rise (p = 0.007). A faint biofilm formation could be seen around the DBS lead by day-2 and florid growth by day-3. After addition of the linezolid solution, a 15.9 % decrease in monopolar impedance was observed from day 3-6 (p = 0.003).

Conclusion: This study gives insight into impedance trends following a hardware infection in DBS. Increased impedance outside expected norms may be valuable for early prediction of infection. Furthermore, timely management using antibiotics might reduce the frequency of infection-related explant surgeries.

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Source
http://dx.doi.org/10.1016/j.jocn.2024.01.004DOI Listing

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