Wolf Marc E, Klockziem Matti, Majewski Olaf, Schulte Dirk Michael, Krauss Joachim K, Blahak Christian
Department of Neurology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany,
Department of Neurology, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany,
Stereotact Funct Neurosurg. 2019;97(5-6):362-368. doi: 10.1159/000505076. Epub 2020 Jan 16.
Deep brain stimulation (DBS) for movement disorders has been mainly performed with constant voltage (CV) technology. More recently also constant current (CC) systems have been developed which theoretically might have additional advantages. Furthermore, rechargeable (RC) system implantable pulse generators (IPG) are increasingly being used rather than the former solely available non-rechargeable (NRC) IPGs.
To provide a systematic investigation how to proceed and adapt settings when switching from CV NRC to CC RC technology.
We prospectively collected data from 11 consecutive patients (10 men, mean age at DBS implantation 52.6 ± 14.0 years) with chronic DBS for dystonia (n = 7), Parkinson disease (n = 3), and essential tremor (n = 1) who underwent IPG replacement switching from a CV NRC system (Activa® PC; Medtronic®) to a CC RC system (Vercise® RC; Boston Scientific®). Systematic assessments before and after IPG replacement were performed.
DBS technology switching at the time of IPG replacement due to battery depletion was at a mean of 108.5 ± 46.2 months of chronic DBS. No perioperative complications occurred. Clinical outcome was stable with overall mild improvements or deteriorations, which could be dealt with in short-term follow-up. Patients were satisfied with the new RC IPG.
This study confirms both the safety and feasibility of switching between different DBS technologies (CV to CC, NRC to RC, different manufacturers) in patients with chronic DBS. Furthermore, it shows how the management can be planned using available information from the previous DBS settings. Individual assessment is needed and might partly be related to the DBS target and the underlying disease. MR safety might be a problem with such hybrid systems.
用于运动障碍的脑深部电刺激（DBS）主要采用恒压（CV）技术进行。最近也开发了恒流（CC）系统，理论上可能具有更多优势。此外，可充电（RC）系统植入式脉冲发生器（IPG）越来越多地被使用，而不是以前唯一可用的不可充电（NRC）IPG。
提供一项关于从CV NRC技术转换为CC RC技术时如何进行及调整设置的系统研究。
我们前瞻性地收集了11例连续患者（10例男性，DBS植入时平均年龄52.6±14.0岁）的数据，这些患者因肌张力障碍（n = 7）、帕金森病（n = 3）和特发性震颤（n = 1）接受慢性DBS治疗，他们接受了IPG更换，从CV NRC系统（Activa® PC；美敦力®）转换为CC RC系统（Vercise® RC；波士顿科学®）。在IPG更换前后进行了系统评估。
由于电池耗尽在IPG更换时进行DBS技术转换的平均慢性DBS时间为108.5±46.2个月。未发生围手术期并发症。临床结果稳定，总体有轻度改善或恶化，可在短期随访中处理。患者对新的RC IPG感到满意。
本研究证实了慢性DBS患者在不同DBS技术（CV至CC、NRC至RC、不同制造商）之间转换的安全性和可行性。此外，它展示了如何利用先前DBS设置中的可用信息来规划管理。需要进行个体评估，且可能部分与DBS靶点和潜在疾病有关。此类混合系统的磁共振安全性可能是个问题。
