Is Magnetic Resonance Imaging Safe for Patients with Neurostimulation Systems Used for Deep Brain Stimulation?

Abstract

n this article, we report to the neurosurgi-cal community important safety concernsrelated to the use of magnetic resonanceimaging (MRI) in patients with neurostimula-tion systems used for deep brain stimulation(DBS). The significance of these concerns isunderscored by our case report in this issueand another published recently (19). Thealarming report of a patient with a DBS im-plant experiencing adverse effects in associa-tion with an MRI examination emphasizes thecrucial importance of strictly following safetyrecommendations. Any attempt to generalizeor trivialize these safety aspects may result inserious temporary or permanent injury to thepatient.The DBS-Magnetic Resonance (DBS-MR)Safety Cooperative Group includes a consor-tium of experts in the fields of MR safety,biomedical engineering, radiology, and neu-rosurgery who have systematically studiedMRI safety for neurostimulation systems forthe past 4 years. In this issue, our group pre-sents a report of a patient who underwentMRI with adverse effects and report the latestfindings with respect to DBS and MRI safety.Of note is that the Food and Drug Adminis-tration recently issued a warning regardingthe use of MRI in patients with neurostimula-tion systems (23).The therapeutic use of electrical stimulationto treat neurological disorders is rapidlygrowing. There are more than 100,000 im-planted neurostimulation devices consistingof DBS, motor cortex stimulation, spinal cordstimulation, vagal nerve stimulation, and pe-ripheral nerve stimulation devices. The num-ber of patients with neurostimulation im-plants is increasing, clinical indications areevolving, and an increasing number of manu-facturers are providing Food and DrugAdministration-approved, or -pending, sys-tems.The focus of this Special Commentary is DBS.With more than 30,000 DBS implants world-wide and Food and Drug Administration-approved indications for treating Parkinson’sdisease, essential tremor, and dystonia, DBS isone of the most rapidly growing areas in thefield of neurosurgery (12, 20, 22). In addition, anumber of clinical trials are underway to assessthe role of DBS in treating epilepsy, chronicpain, cluster headaches, obsessive-compulsivedisorder, major depression, and other relatedconditions.Despite rapid growth in neurostimulationtechnologyandclinicalapplication,therehavebeen few studies directed at assessing thesafety of performing MRI procedures on pa-tients with DBS implants. The neurosurgery,neurology, and radiology communities havenot, for the most part, addressed the safetyfactors of DBS and MRI. The use of MRI pro-cedures for patients with DBS involves vari-ousapproaches. Certaincentersroutinely scanpatients with DBS devices based on thepremise that there have been no problems inthose scanned in the past. In other centers,MRI examinations of patients with DBS im-plants is strictly prohibited, as it is with pa-tients with cardiac pacemakers (1, 14–16).Other centers use various approaches and pol-icies in between.Importantly, the necessity of using MRI ex-aminations in these patients is implicit (3, 4,12, 13). MRI is important for the diagnosis ofhemorrhage, stroke, and other intracranial le-sions; for the assessment of the progression ofneurodegenerative disorders; and for the eval-uation of spinal disorders. In addition, MRI isbeneficial for determining postoperative DBSlead location, crucial for the evaluation of pa-tients with suboptimal results or side effects,