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Disease-specific longevity of impulse generators in deep brain stimulation and review of the literature

  • Neurology and Preclinical Neurological Studies - Original Article
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Abstract

Deep brain stimulation (DBS) represents an established and internationally approved therapy for movement disorders. In the present retrospective analysis, we evaluated disease-specific longevity of dual channel impulse generators (IPG) used in different movement disorders. We correlated the battery lifetime with electrical stimulation settings, “total electrical energy delivered” (TEED), stimulation modi (monopolar, double monopolar and bipolar) and targets. Specifically, we reviewed the longevity and stimulation settings of 464 IPGs implanted between 1996 until 2011 in a single university center. Disease entities comprised Parkinson’s disease (PD, n = 257), dystonia (n = 130) and essential tremor (ET, n = 50). Further subanalyses aimed at assessing differential longevity in different subtypes of PD and dystonia. The main finding relates to longer IPG longevity in ET (thalamic DBS) and PD (subthalamic DBS) vs. dystonia (pallidal DBS; 71.9 ± 6.7 vs. 51.5 ± 2.3 vs. 37 ± 2 months). In PD the tremor-dominant type was associated with a significant shorter battery survival than in the akinetic-rigid type without tremor or the “balanced” type with tremor, bradykinesia and rigidity (38.8 ± 3.9 vs. 53.6 ± 3.4 vs. 58.8 ± 4.1 months), while there were no significant differences in longevity between the subtypes of dystonia. Frequency, amplitude, pulse widths and TEED correlated inversely with battery lifetime. Pallidal DBS in dystonia is associated with a shorter lifetime of IPGs than subthalamic or thalamic DBS for PD or ET. The present results may contribute to the rapidly evolving refinement of DBS devices. Future studies that assess energy consumption both in patients with and without IPG replacement could help to avoid potential underestimation of longevity of IPGs.

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Abbreviations

DBS:

Deep brain stimulation

EOL:

End of life

ESS:

Electrical stimulation settings

ET:

Essential tremor

GPi:

Globus pallidus internus

IPG:

Impulse generator

PD:

Parkinson’s disease

STN:

Subthalamic nucleus

TEED:

Total electrical energy delivered

VIM:

Ventral intermediate nucleus

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Authors and Affiliations

  1. Department of Neurology & Neurosurgery, Charite University Medicine Berlin, Campus Virchow Klinikum & Benjamin Franklin, Berlin, Germany

    Christoph van Riesen, Georg Tsironis, Doreen Gruber, Fabian Klostermann, Patricia Krause & Gerd Helge Schneider

  2. Kliniken Beelitz, Movement Disorder Clinic, Paracelsusring 6 a, Beelitz-Heilstätten, Germany

    Doreen Gruber

  3. Department of Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Str. 44, Magdeburg, Germany

    Andreas Kupsch

  4. NEUROLOGY MOVES, Bismarckstr. 45-47, Berlin, Germany

    Andreas Kupsch

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  1. Christoph van Riesen
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  2. Georg Tsironis
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  3. Doreen Gruber
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  4. Fabian Klostermann
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  5. Patricia Krause
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  6. Gerd Helge Schneider
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  7. Andreas Kupsch
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Correspondence to Andreas Kupsch.

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Funding

This study was funded by Deutsche Forschungsgemeinschaft (Grant number GE 2629/1-1) and the German Ministry of Education and Research.

Conflict of interest

Andreas Kupsch: Consultancies: none; Advisory Boards: Medtronic USA; Honoraria for speaking from Abbvie, Allergan, Boehringer Ingelheim, Desitin, Ipsen Pharma, Lundbeck, Medtronic, Merck, Merz Pharmaceuticals, Orion, St. Jude UCB. The authors declare that they have no conflict of interest.

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van Riesen, C., Tsironis, G., Gruber, D. et al. Disease-specific longevity of impulse generators in deep brain stimulation and review of the literature. J Neural Transm 123, 621–630 (2016). https://doi.org/10.1007/s00702-016-1562-1

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