Département de neurologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, Strasbourg, France; Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United-Kingdom; Inserm-U964/CNRS-UMR7104, institut de génétique et de biologie moléculaire et cellulaire (IGBMC), université de Strasbourg, Illkirch, France.
Neurologie C, hôpital neurologique Pierre-Wertheimer, hospices civils de Lyon, Lyon, France; CNRS, UMR 5229, institut des sciences cognitives Marc-Jeannerod, Bron, France.
Rev Neurol (Paris). 2021 Mar;177(3):283-289. doi: 10.1016/j.neurol.2020.02.007. Epub 2020 Apr 15.
Little is known about outcome and settings adaptations after replacement of constant-voltage non-rechargeable implantable pulse generator (CV-nrIPG) by constant-current rechargeable IPG (CC-rIPG).
To determine the feasibility and safety of replacing a CV-nrIPG by a CC-rIPG in Parkinson's disease (PD) and the subsequent outcome.
A prospective cohort of thirty PD patients, whose CV-nrIPG was replaced by a CC-rIPG in University Hospital of Lyon between January 2017 and December 2018 (rIPG group) and 39 PD patients, who underwent the replacement of a CV-nrIPG by the same device in 2016 (nrIPG group), were enrolled in this study. Three surgeons performed the operations. Duration of hospitalization for the replacement as well as the number of in or outpatient visits during the first 3 months after the surgery were recorded. In the rIPG group, we compared preoperative DBS settings and the theoretical amplitude estimated using Ohm's law to the amplitude used at the end of follow-up. We assessed patients' and clinicians' opinion on the patient global functioning after the replacement using Clinical Global Impression score.
Duration of hospitalization (P=0.47) and need for additional hospitalizations (P=0.73) or consultations (P=0.71) to adapt DBS parameters did not differ between the two groups. Neurological condition (CGI score) was considered as unchanged by both patients and neurologists. Final amplitude of stimulation using CC-rIPG was not predicted by Ohm's law in most cases.
Replacing CV-nrIPG by CC-rIPG is safe and well tolerated but require neurological expertise to set the new parameters of stimulation.
对于使用恒流可充电植入式脉冲发生器（CC-rIPG）替代恒压不可充电植入式脉冲发生器（CV-nrIPG）后的结果和设置调整，人们知之甚少。
确定在帕金森病（PD）患者中用 CC-rIPG 替代 CV-nrIPG 的可行性和安全性，以及随后的结果。
本前瞻性队列研究纳入了 2017 年 1 月至 2018 年 12 月在里昂大学医院接受 CV-nrIPG 更换为 CC-rIPG 的 30 例 PD 患者（rIPG 组）和 2016 年接受相同设备更换的 39 例 PD 患者（nrIPG 组）。三名外科医生进行了手术。记录更换手术的住院时间以及术后 3 个月内的门诊和住院就诊次数。在 rIPG 组，我们比较了术前 DBS 设置和使用欧姆定律估计的理论幅度与随访结束时使用的幅度。我们使用临床总体印象评分评估患者更换后的总体功能。
两组间住院时间（P=0.47）和调整 DBS 参数所需的额外住院次数（P=0.73）或就诊次数（P=0.71）无差异。患者和神经科医生均认为神经状况（CGI 评分）无变化。在大多数情况下，使用 CC-rIPG 的最终刺激幅度不能用欧姆定律预测。
用 CC-rIPG 替代 CV-nrIPG 是安全且耐受良好的，但需要神经科专家来设置新的刺激参数。
