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Making MRI Safe for Patients with Stimulators

Epilepsy is typically managed via medication, but many patients also receive implanted nerve stimulators to help control their symptoms.

A procedure to cure certain types of epilepsy was developed by a surgeon in the Division of Pediatric Epilepsy at University Hospitals Cleveland Medical Center in Cleveland, Ohio, but it came with a big drawback: the surgery requires magnetic resonance imaging (MRI) for pre-surgical evaluation and planning to determine whether a patient can benefit from it.

“Our hospital had a strict policy prohibiting MRI of patients with any kind of active implanted electrical or electronic devices—including nerve stimulators,” says David W. Jordan, senior diagnostic medical physicist for University Hospitals Cleveland Medical Center.

At the time, the only way to determine whether a patient with a stimulator could have the curative surgery would have been to surgically remove their stimulator before a MRI scan. “This was unacceptable to the epilepsy team, because it would involve removing many working stimulators…and those patients who turned out to not be surgical candidates would now be left without a working stimulator to manage their epilepsy symptoms,” he recounts.

To find a solution, Jordan created a working group that brought together the epilepsy team, radiologists, and the manufacturer of the stimulator to evaluate potentially safe MRI approaches for these patients. He worked with the stimulator company to review all of the information and data they had about MRI safety conditions and tests for their devices. At the same time, he determined the technical capabilities of the hospital’s various MRI scanners, and presented the device and scanner information to the radiologists.

“We reviewed possible MRI approaches that would satisfy the documented safety conditions for implants,” says Jordan. “Then I worked with the epilepsy team to explain the features and limitations of our MRI scanners to ensure our approach would suit their needs. With agreement from both sides, we proposed an updated implant policy to the hospital’s risk managers.” They approved.

Now, the epilepsy team has a “feasible approach to evaluate stimulator-managed patients for curative surgery and, in the process, our MRI department became a referral center for stimulator patients who are unable to get MRI studies at other centers,” he adds. “And the stimulator manufacturer is using our experience as a case study to help other centers set up programs for safe MRI scanning for their stimulator patients.”

You can watch a video of the procedure here.

Epilepsy Surgery Case Study