title: Cutaneous electrosurgery in a patient with a deep brain stimulator.
abstract: BACKGROUND
  Deep brain stimulators are implantable devices with electrical activity used to treat certain movement disorders such as essential tremor and Parkinson's disease. Similar to implantable cardiac devices, use of electrosurgery on patients with these devices may produce adverse effects.
  
  
  METHODS
  We describe the effects of electrosurgery on a patient with essential tremor and an implantable deep brain stimulator who required Mohs micrographic surgery to excise a basal cell carcinoma. The patient experienced immediate lancinating "electrical shock" using electrosurgery in the monopolar mode. The patient experienced no discomfort when a bipolar electrosurgical device was used or when his deep brain stimulator was "turned off." Appropriate positioning of the dispersive plate also reduced adverse effects.
  
  
  CONCLUSIONS
  Dermatologic surgeons should be aware of patients with devices implanted in the CNS with electrical activity and proceed with caution when using electrosurgery. Different approaches can be utilized to help reduce adverse effects.
authors.affiliation: Department of Dermatology, Loma Linda University Medical Center, Loma Linda, California, USA.
authors.forename: J
authors.initials: J
authors.lastname: Weaver
authors.forename: S J
authors.initials: SJ
authors.lastname: Kim
authors.forename: M H
authors.initials: MH
authors.lastname: Lee
authors.forename: A
authors.initials: A
authors.lastname: Torres
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain; D002280:Basal Cell Carcinoma / Q000601:surgery*; D006801:Humans; D008297:Male; D015580:Mohs Surgery / Q000009:adverse effects*; D012878:Skin Neoplasms / Q000601:surgery*; D004561:Transcutaneous Electric Nerve Stimulation / Q000009:adverse effects*; D014202:Tremor / Q000628:therapy*