van Riesen Christoph, Tsironis Georg, Gruber Doreen, Klostermann Fabian, Krause Patricia, Schneider Gerd Helge, Kupsch Andreas
Department of Neurology & Neurosurgery, Charite University Medicine Berlin, Campus Virchow Klinikum & Benjamin Franklin, Berlin, Germany.
Kliniken Beelitz, Movement Disorder Clinic, Paracelsusring 6 a, Beelitz-Heilstätten, Germany.
J Neural Transm (Vienna). 2016 Jun;123(6):621-30. doi: 10.1007/s00702-016-1562-1. Epub 2016 May 19.
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.
深部脑刺激（DBS）是一种已确立且获得国际认可的治疗运动障碍的方法。在本次回顾性分析中，我们评估了用于不同运动障碍的双通道脉冲发生器（IPG）的疾病特异性使用寿命。我们将电池寿命与电刺激设置、“总输送电能”（TEED）、刺激模式（单极、双单极和双极）以及靶点进行了关联。具体而言，我们回顾了1996年至2011年间在单一大学中心植入的464个IPG的使用寿命和刺激设置。疾病类型包括帕金森病（PD，n = 257）、肌张力障碍（n = 130）和特发性震颤（ET，n = 50）。进一步的亚分析旨在评估PD和肌张力障碍不同亚型的差异使用寿命。主要发现是，与肌张力障碍（苍白球DBS）相比，ET（丘脑DBS）和PD（丘脑底核DBS）的IPG使用寿命更长（分别为71.9±6.7个月、51.5±2.3个月和37±2个月）。在PD中，震颤为主型的电池存活时间明显短于无震颤的运动不能 - 强直型或伴有震颤、运动迟缓及强直的“平衡”型（分别为38.8±3.9个月、53.6±3.4个月和58.8±4.1个月），而肌张力障碍各亚型之间的使用寿命无显著差异。频率、幅度、脉冲宽度和TEED与电池寿命呈负相关。与用于PD或ET的丘脑底核或丘脑DBS相比，肌张力障碍的苍白球DBS与IPG的较短使用寿命相关。目前的结果可能有助于DBS设备的快速改进。未来评估有无更换IPG患者能量消耗的研究可能有助于避免对IPG使用寿命的潜在低估。
