Shorter Pulse Generator Longevity and More Frequent Stimulator Adjustments With Pallidal DBS for Dystonia Versus Other Movement Disorders

Abstract

Background: Deep brain stimulation has become a routine therapy for movement disorders, but it is relatively invasive and costly. Although stimulation intensity relates to battery longevity, less is known about how diagnosis and stimulation target contribute to this clinical outcome. Here we evaluate battery longevity in movement disorders patients who were treated at a tertiary referral center. Objective: To compare single channel pulse generator longevity in patients with movement disorders. Methods: With Institutional Review Board approval, we evaluated 470 consecutive Soletra implants for routine care. Battery longevity was estimated with Kaplan-Meier analyses, and group comparisons were performed with the log rank mean test. The frequency of clinic encounters for ongoing care was evaluated across diagnoses with analysis of variance (ANOVA). Results: The mean pulse generator longevity was 44.9±1.4 months. Pallidal DBS for dystonia was associated with shorter battery longevity than subthalamic and thalamic DBS for Parkinson's disease and essential tremor (28.1±2.1 versus 47.1±1.8 and 47.8±2.6 months, respectively, mean ± standard error, p<0.001), and dystonia patients required more frequent clinic visits for routine care (F=6.0, p=0.003). Pallidal DBS for Parkinson's disease and thalamic DBS for cerebellar outflow tremor were associated with shorter battery longevity, as well (35.3±4.6 and 26.4±4.3 months, respectively). Conclusions: Pallidal DBS for dystonia was associated with shorter battery longevity and more frequent stimulator adjustments versus DBS for Parkinson’s disease and essential tremor. Characteristics of the stimulation target and disease pathophysiology both likely contribute to battery longevity in patients with movement disorders.

Battery Longevity Comparison of Two Commonly Available Dual Channel Implantable Pulse Generators Used for Subthalamic Nucleus Stimulation in Parkinson’s Disease

“…Targeting of the Globus Pallidus Interna in PD has also been associated with a reduction in battery life when compared to stimulation of the STN. This is hypothesised to be due to the larger size of the Globus Pallidus Interna in comparison to the STN, therefore requir- ing larger stimulation voltages to produce symptomatic benefit [19]. As the targeting of the STN for the treatment of PD is the most commonly performed procedure in our centre, we have therefore focused exclusively on battery life in this condition to minimise the number of potential variables introduced and to ensure a sufficient number of patients are included for statistical analysis.…”

“…We have therefore set out to compare if there is any significant difference in battery life between the Medtronic Kinetra IPG and the Activa PC, which has now come to replace it. Despite manufacturer battery life estimates of between 3 and 5 years for the Activa PC IPG, studies have found a significant difference in battery longevity depending on the DBS target and disease pathophysiology being treated [17][18][19]. We have therefore only compared battery life in the DBS treatment of PD through the targeting of a single nucleus, the STN.…”

Spatial Topographies of Unilateral Subthalamic Nucleus Deep Brain Stimulation Efficacy for Ipsilateral, Contralateral, Midline, and Total Parkinson Disease Motor Symptoms

“…At approximately 1 month postoperatively, the DBS system was interrogated and adjusted to maximal clinical efficacy using standard methods that we have described previously. 36 A volumetric T1-weighted MRI scan was obtained on postoperative day 1. Customized software was used to calculate the DBS electrode contact locations.…”

A pilot trial of square biphasic pulse deep brain stimulation for dystonia: The BIP dystonia study

“…DBS is an effective surgical therapy for select dystonia patients who are refractory to medications or in those who have focal neck or generalized symptoms . Although DBS can be effective, dystonia patients frequently require detailed programming to achieve satisfactory clinical benefit.…”

“…Although DBS can be effective, dystonia patients frequently require detailed programming to achieve satisfactory clinical benefit. Dystonia patients often more energy‐demanding stimulation settings that may lead to stimulation‐induced side effects (e.g., pulling from internal capsule stimulation) and have been demonstrated to directly affect battery drain . This point is particularly important for generalized dystonia patients implanted at a younger age and could, over a lifetime, undergo many surgical interventions .…”