Characteristics of the induced voltage between deep brain stimulation (DBS) device electrodes by a transcranial magnetic stimulation (TMS) device

The combination of deep brain stimulation (DBS) and transcranial magnetic stimulation (TMS) is expected to provide additional insights into the pathophysiology of some brain diseases. However, when using TMS in patients with DBS implants, the induced voltage between DBS electrodes presents the greatest risk of brain damage. This paper describes the characteristics of the induced DBS electrode voltage due to TMS. We first examined the TMS stimulus signal and the DBS output impedance characteristics, and then experimentally investigated the induced DBS electrode voltage for various DBS and TMS conditions. The results show that many factors impact the induced electrode voltage. The induced electrode voltage with DBS device working in the unipolar mode is greater than that with DBS device working in the bipolar mode. No matter DBS device is turned on or turned off, the induced electrode voltage is almost the same, but it can provide a significant addition to the original stimulus waveform. There are no significant differences in the induced DBS electrode voltage when the DBS system is working at different stimulus intensities. Lowering the TMS stimulus intensity could effectively reduce the induced DBS electrode voltage. The induced electrode voltage is also strongly related to the position of the TMS coil relative to the DBS lead. This study provides further information about the characteristics of the induced DBS electrode voltage in TMS applications and a reference for the combined use of DBS and TMS.