DBS Electrodes With Single Disconnected Contacts: Long-Term Observation and Implications for the Management.

OBJECTIVES: To evaluate the long-term course of quadripolar DBS electrodes with disconnected single contacts that cannot be used for DBS. MATERIALS AND METHODS: Quadripolar electrodes with open circuits of single contacts or monopolar impedances >6500 Ω were identified from a cohort of 2082 electrodes from 1044 patients with variable movement disorders. The long-term course was analyzed from follow-up data. RESULTS: Disconnected contacts were found in 58 electrodes (2.8%) from 49 patients (4.7%). The dysfunction was restricted to one contact in 51 electrodes (87.9%), two contacts in 5 electrodes (8.6%), three contacts in 2 electrodes (3.4%). Onset was related to surgery (implantation, impulse generator replacement, or other surgical revision) in 34 electrodes (58.6%), trauma in 2 electrodes, undetermined in 11 electrodes, and occurred spontaneously after previous normal measurements in 11 electrodes (19.0%). Repeated measurements at follow-ups of ≥3 months were available in 39 electrodes. In 16 electrodes (41.0%) abnormal impedances persisted constantly during observations up to 11½ years (47 ± 35 months, median 41 months). In 21 electrodes (53.8%) abnormal impedances remained restricted to the initial contact(s) but varied considerably between measurements during up to six years (39 ± 18 months, median 38 months). Only two electrodes (5.1%) with initially one disconnected contact developed a disconnection of a second contact. CONCLUSIONS: Disconnections of single contacts occur with increasing cumulative incidence during long-term DBS. Surgery is the main causative risk factor. In the majority of electrodes, the dysfunction remains restricted to the initial contact(s).

Long-Term Stability of Short Circuits in Deep Brain Stimulation.

OBJECTIVES: To evaluate the long-term course of DBS electrodes with short-circuited contacts. MATERIALS AND METHODS: Electrodes with bipolar impedances below 150 Ω were identified from a cohort of 1044 patients with 2082 electrodes for variable movement disorders. The long-term course was analyzed from follow-up data. RESULTS: Short circuits were found in 62 electrodes (3.0%) from 60 patients (5.7%). They were restricted to two contacts in 57 electrodes (91.9%) and included more than two contacts in five electrodes. Onset was related to surgery (implantation, impulse generator replacements, or other surgical revisions) in 42 electrodes (67.7%). The onset was undetermined in 11 electrodes. In eight electrodes (12.9%) with previously normal impedances, the short circuit occurred spontaneously during long-term DBS and in one electrode after a fall. Repeated impedance checks at follow-ups of ≥3 months were available in 41 electrodes with short circuits. Twenty-six electrodes (63.4%) showed stable low impedances during observation up to nine years and two months (median 29 months). In four electrodes low impedances were stable until surgical revisions. In eight electrodes (19.5%) with observation up to nine years and seven months (median 54 months), short circuits were only detected intermittently but remained restricted to two contacts. In three electrodes (7.3%) intermittent short circuits between more than two contacts were found during long-term DBS. CONCLUSIONS: An increasing cumulative incidence demonstrates the clinical importance of short circuits. In the majority of electrodes, short circuits are restricted and remain restricted to two contacts during long-term stimulation.

gammaAla82Gly represents a common fibrinogen gamma-chain variant in Caucasians.

Screening of 200 blood donors for the presence of polymorphisms in three fibrinogen genes (FGA, FGB, FGG), revealed two individuals with a heterozygous missense mutation (c.323C > G, gammaAla82Gly) in the FGG gene. This mutation has been reported previously to cause mild hypofibrinogenaemia. Analysis of an additional 416 blood donors showed two more heterozygous gammaAla82Gly mutations, resulting in an overall gammaAla82Gly allele frequency of 0.0032. Haplotype analysis demonstrated that the gammaAla82Gly mutation originated from a common founder. From these data we estimated that homozygous individuals for gammaAla82Gly should occur at a frequency of 1: 95 000, suggesting that hypofibrinogenaemia represents a more frequent condition in the population than so far believed.