title: Positioning of vagal nerve stimulators: technical note.
abstract: BACKGROUND
  Vagal nerve stimulation has become an important treatment for patients with intractable seizure disorders. Many of these patients will require magnetic resonance imaging (MRIs) of the brain after the stimulator has been implanted to monitor underlying neurologic conditions. Functional MRI (fMRI) is also being used in the evaluation of epilepsy. With the current recommended implant techniques the magnetic field of the MRI will deactivate the pulse generator while the patient is in the supine position for the scan. A simple change in positioning of the pulse generator will help to avoid deactivating the device during an MRI. This will avoid exposing the patient to lengthy time periods with a deactivated stimulator and also allow for the performance of fMRIs and any other MRI scans needed to monitor underlying neurologic conditions.
  
  
  METHODS
  A working model of the NeuroCybernetic Prosthesis (NCP) pulse generator was assessed with an oscilloscope and LED light connected to it that related activation of the generator while in the MRI. This simulation was performed with the device alone, in multiple positions. Then patients with implanted devices who could personally confirm the activation of their stimulators were also studied.
  
  
  RESULTS
  A pulse generator placed with the electrode inputs parallel to the long axis of the body was not deactivated by the magnetic field of the MRI when the patient was in the supine position.
  
  
  CONCLUSIONS
  Changing the implant position of a vagal nerve stimulator pulse generator will help to prevent deactivation of the device while in the MRI, allowing for the performance of fMRIs while not exposing the patient to lengthy time periods with a deactivated vagal nerve stimulator.
authors.affiliation: Department of Neurosurgery, New Jersey Medical School, Newark, USA.
authors.forename: A
authors.initials: A
authors.lastname: Maniker
authors.forename: W C
authors.initials: WC
authors.lastname: Liu
authors.forename: D
authors.initials: D
authors.lastname: Marks
authors.forename: K
authors.initials: K
authors.lastname: Moser
authors.forename: A
authors.initials: A
authors.lastname: Kalnin
mesh_terms: D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D004574:Electromagnetic Fields / Q000009:adverse effects; D004827:Epilepsy / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000009:adverse effects; D014630:Vagus Nerve