Movement Disorders Institute and Department of Neurology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
Movement Disorders Institute and Department of Neurology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
Brain Stimul. 2019 Jul-Aug;12(4):845-850. doi: 10.1016/j.brs.2019.02.008. Epub 2019 Feb 22.
People with Parkinson's disease (PD) treated with deep brain stimulation (DBS) with non-rechargeable implantable pulse generators (IPGs) require elective IPG replacement operations involving surgical and anesthesiologic risk. Life expectancy and the number of replacements per patient with DBS are increasing.
To determine whether IPG longevity is influenced by stimulation parameters alone or whether there is an independent effect of the number of battery replacements and IPG model.
PD patients treated with bilateral subthalamic DBS were included if there was at least one IPG replacement due to battery end of life. Fifty-five patients had one or two IPG replacements and seven had three or four replacements, (80 Kinetra and 23 Activa-PC). We calculated longevity corrected for total electrical energy delivered (TEED) and tested for the effect of IPG model and number of previous battery replacements on this measure.
TEED-corrected IPG longevity for the 1 implanted IPG was 51.3 months for Kinetra and 35.6 months for Activa-PC, which dropped by 5.9 months and 2.8 months, respectively with each subsequent IPG replacement (p < 10 for IPG model and p < 10 for IPG number).
Activa-PC has shorter battery longevity than the older Kinetra, battery longevity reduces with repeated IPG replacements and these findings are independent of TEED. Battery longevity should be considered both in clinical decisions and in the design of new DBS systems. Clinicians need accessible, reliable and user-friendly tools to provide online estimated battery consumption and end of life. Furthermore, this study supports the consideration of using rechargeable IPGs in PD.
接受可充式植入式脉冲发生器（IPG）的脑深部电刺激（DBS）治疗的帕金森病（PD）患者需要进行涉及手术和麻醉风险的可充式 IPG 更换手术。DBS 的预期寿命和每位患者的更换次数都在增加。
确定 IPG 的使用寿命是否仅受刺激参数的影响，或者电池更换次数和 IPG 型号是否存在独立影响。
如果因电池寿命结束而至少进行过一次 IPG 更换，则将接受双侧丘脑底核 DBS 治疗的 PD 患者纳入研究。55 名患者进行了一次或两次 IPG 更换，7 名患者进行了三次或四次更换（80 个 Kinetra 和 23 个 Activa-PC）。我们计算了校正总电能输送（TEED）的 IPG 使用寿命，并测试了 IPG 型号和之前电池更换次数对该指标的影响。
对于单个植入的 IPG，Kinetra 的 TEED 校正后的 IPG 使用寿命为 51.3 个月，Activa-PC 的使用寿命为 35.6 个月，随着每次后续的 IPG 更换，使用寿命分别减少了 5.9 个月和 2.8 个月（IPG 型号和 IPG 数量均为 p<10）。
Activa-PC 的电池寿命比较旧的 Kinetra 短，电池寿命会随着重复的 IPG 更换而降低，这些发现与 TEED 无关。在临床决策和新 DBS 系统设计中都应考虑电池寿命。临床医生需要易于访问、可靠且用户友好的工具，以提供在线估计电池消耗和使用寿命结束。此外，本研究支持在 PD 中使用可充式 IPG 的考虑。
