Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Stereotact Funct Neurosurg. 2020;98(5):331-336. doi: 10.1159/000508794. Epub 2020 Jul 15.
A wide range of pulse widths (PWs) has been used in globus pallidus internus (GPi) deep brain stimulation (DBS) for dystonia. However, no specific PW has demonstrated clinical superiority, and the paradigm may differ among DBS centers.
To investigate how different paradigms of PWs in GPi DBS for dystonia affect implantable pulse generator (IPG) longevities and energy consumption.
Thirty-nine patients with dystonia treated with bilateral GPi DBS at 2 Swedish DBS centers from 2005 to 2015 were included. Different PW paradigms were used at the 2 centers, 60-90 µs (short PWs) and 450 µs (long PW), respectively. The frequency of IPG replacements, pulse effective voltage (PEV), IPG model, pre-/postoperative imaging, and clinical outcome based on the clinical global impression (CGI) scale were collected from the medical charts and compared between the 2 groups.
The average IPG longevity was extended for the short PWs (1,129 ± 50 days) compared to the long PW (925 ± 32 days; χ2 = 12.31, p = 0.0005, log-rank test). IPG longevity correlated inversely with PEV (Pearson's r = -0.667, p < 0.0001). IPG longevities did not differ between Kinetra® and Activa® PC in the short (p = 0.319) or long PW group (p = 0.858). Electrode distances to the central sensorimotor region of the GPi did not differ between the short or long PW groups (p = 0.595). Pre- and postoperative CGI did not differ between groups.
Short PWs were associated with decreased energy consumption and increased IPG longevity. These effects were not dependent on the IPG model or the anatomic location of the electrodes. PWs did not correlate with symptom severities or clinical outcomes. The results suggest that the use of short PWs might be more energy efficient and could therefore be preferred initially when programming patients with GPi DBS for dystonia.
在苍白球 internus（GPi）深部脑刺激（DBS）治疗肌张力障碍中，已经使用了多种脉冲宽度（PW）。然而，没有特定的 PW 表现出临床优越性，并且范式可能在不同的 DBS 中心之间有所不同。
研究 GPi DBS 中不同的 PW 范式治疗肌张力障碍如何影响可植入脉冲发生器（IPG）的寿命和能量消耗。
纳入了 2005 年至 2015 年在瑞典的 2 个 DBS 中心接受双侧 GPi DBS 治疗的 39 例肌张力障碍患者。这 2 个中心分别使用了不同的 PW 范式，分别为 60-90µs（短 PW）和 450µs（长 PW）。从病历中收集了 IPG 更换频率、脉冲有效电压（PEV）、IPG 模型、术前/术后影像学以及基于临床总体印象（CGI）量表的临床结果，并比较了 2 组之间的差异。
与长 PW（925±32 天）相比，短 PW（1129±50 天）的 IPG 平均寿命延长（χ2=12.31，p=0.0005，对数秩检验）。IPG 寿命与 PEV 呈负相关（Pearson r=-0.667，p<0.0001）。在短 PW 或长 PW 组中，Kinetra®和 Activa® PC 之间的 IPG 寿命没有差异（p=0.319 和 p=0.858）。GPi 的中央感觉运动区到电极的距离在短 PW 或长 PW 组之间没有差异（p=0.595）。组间术前和术后的 CGI 没有差异。
短 PW 与能量消耗减少和 IPG 寿命延长有关。这些效果不依赖于 IPG 模型或电极的解剖位置。PW 与症状严重程度或临床结果无关。结果表明，在为 GPi DBS 治疗肌张力障碍的患者编程时，使用短 PW 可能更节能，因此最初可能更受欢迎。
