Deng Zhi-De, Hardesty David E, Lisanby Sarah H, Peterchev Angel V
Department of Electrical Engineering, Columbia University / New York State Psychiatric Institute, NY 10032, USA.
Annu Int Conf IEEE Eng Med Biol Soc. 2010;2010:2049-52. doi: 10.1109/IEMBS.2010.5626517.
The safety of electroconvulsive therapy (ECT) in patients who have deep brain stimulation (DBS) implants represents a significant clinical issue. A major safety concern is the presence of burr holes and electrode anchoring devices in the skull, which may alter the induced electric field distribution in the brain. We simulated the electric field using finite-element method in a five-shell spherical head model. Three DBS electrode anchoring techniques were modeled, including ring/cap, microplate, and burr-hole cover. ECT was modeled with bilateral (BL), right unilateral (RUL), and bifrontal (BF) electrode placements and with clinically-used stimulus current amplitude. We compared electric field strength and focality among the DBS implantation techniques and ECT electrode configurations. The simulation results show an increase in the electric field strength in the brain due to conduction through the burr holes, especially when the burr holes are not fitted with nonconductive caps. For typical burr hole placement for subthalamic nucleus DBS, the effect on the electric field strength and focality is strongest for BF ECT, which runs contrary to the belief that more anterior ECT electrode placements are safer in patients with DBS implants.
对于植入脑深部电刺激（DBS）的患者，电休克疗法（ECT）的安全性是一个重大临床问题。一个主要的安全担忧是颅骨中存在钻孔和电极固定装置，这可能会改变大脑中感应电场的分布。我们在一个五层球形头部模型中使用有限元方法模拟电场。对三种DBS电极固定技术进行了建模，包括环形/帽状、微型板和钻孔覆盖物。ECT的建模采用双侧（BL）、右侧单侧（RUL）和双额叶（BF）电极放置方式以及临床使用的刺激电流幅度。我们比较了DBS植入技术和ECT电极配置之间的电场强度和聚焦性。模拟结果表明，由于电流通过钻孔传导，大脑中的电场强度会增加，尤其是当钻孔未安装非导电帽时。对于丘脑底核DBS的典型钻孔位置，BF ECT对电场强度和聚焦性的影响最强，这与认为在植入DBS的患者中ECT电极放置更靠前更安全的观点相反。
