Pulse Width and Implantable Pulse Generator Longevity in Pallidal Deep Brain Stimulation for Dystonia: A Population-Based Comparative Effectiveness Study

Abstract

Introduction: A wide range of pulse widths (PWs) has been used in globus pallidus internus (GPi) deep brain stimulation (DBS) for dystonia. However, no specific PW has demonstrated clinical superiority, and the paradigm may differ among DBS centers. Objective: To investigate how different paradigms of PWs in GPi DBS for dystonia affect implantable pulse generator (IPG) longevities and energy consumption. Methods: Thirty-nine patients with dystonia treated with bilateral GPi DBS at 2 Swedish DBS centers from 2005 to 2015 were included. Different PW paradigms were used at the 2 centers, 60-90 µs (short PWs) and 450 µs (long PW), respectively. The frequency of IPG replacements, pulse effective voltage (PEV), IPG model, pre-/postoperative imaging, and clinical outcome based on the clinical global impression (CGI) scale were collected from the medical charts and compared between the 2 groups. Results: The average IPG longevity was extended for the short PWs (1,129 ± 50 days) compared to the long PW (925 ± 32 days; χ 2 = 12.31, p = 0.0005, log-rank test). IPG longevity correlated inversely with PEV (Pearson's r =-0.667, p < 0.0001). IPG longevities did not differ between Kinetra ® and Activa ® PC in the short (p = 0.319) or long PW group (p = 0.858). Electrode distances to the central sensorimotor region of the GPi did not differ between the short or long PW groups (p = 0.595). Pre-and postoperative CGI did not differ between groups. Conclusions: Short PWs were associated with decreased energy consumption and increased IPG longevity. These effects were not dependent on the IPG model or the anatomic location of the electrodes. PWs did not correlate with symptom severities or clinical outcomes. The results suggest that the use of short PWs might be more energy efficient and could therefore be preferred initially when programming patients with GPi DBS for dystonia.

Deep brain stimulation in dystonia: factors contributing to variability in outcome in short and long term follow-up

“…Although there is no absolute consensus regarding the optimal stimulation parameters for dystonia DBS, some general points can be made. Longer pulse widths above 60 ms, often employed, are no more effective than shorter pulse widths and may induced more side effects and battery drain [73][74][75]. Typically, high-frequency stimulation of 130 Hz is used but lower frequencies of 60 Hz can be of similar efficacy with potentially fewer side effects [76].…”

Pallidal Deep Brain Stimulation for Monogenic Dystonia: The Effect of Gene on Outcome

“…Chronic stimulation in the most posteroventral portion of GPi is most effective (23). Dystonia DBS typically requires higher electrical parameters than STN DBS for Parkinson's disease, however longer stimulation pulse widths above 60 ms are not beneficial and are less energy efficient (24)(25)(26), while lower frequency stimulation below 100 Hz may be useful in selected patients (27). Rare treatment failures after GPi DBS may occur in all categories of dystonia including genetic isolated generalized dystonia and appear independent of technical reasons such poor lead placement (28).…”

Evaluating the Longevity of Implantable Pulse Generator Used in Deep Brain Stimulation: A Systematic Review

“…On the other hand, Lumsden et al acknowledged that no difference in battery life was observed between Soletra® and Kinetra® IPGs [14]. Fakhar et al and Ågren et al showed that battery life is not different in different models [35,36]; thus, it can be concluded that the life of embedded batteries in addition to differ- ent models also depends on different diseases because the settings of the DBS device are different for different patients. For example, depending on the type of malfunction, the lower the set frequency of the device, the longer the battery life is to 48 months [26,37,38], which can be seen in different statistical populations of studies.…”