Willems Yara Rosalie, van der Gaag Niels Anthony, Kho Kuan Hua, Tveiten Øystein Vesterli, Krüger Marie Therese, Jakobs Martin
Department of Neurosurgery, University Neurosurgical Centrum Holland (UNCH), The Hague, The Netherlands.
Department of Neurosurgery, Neurocenter Medisch Spectrum Twente, Enschede, The Netherlands.
Stereotact Funct Neurosurg. 2023;101(2):135-145. doi: 10.1159/000529495. Epub 2023 Mar 8.
The success of deep brain stimulation (DBS) treatment depends on several factors, including proper patient selection, accurate electrode placement, and adequate stimulation settings. Another factor that may impact long-term satisfaction and therapy outcomes is the type of implantable pulse generator (IPG) used: rechargeable or non-rechargeable. However, there are currently no guidelines on the choice of IPG type. The present study investigates the current practices, opinions, and factors DBS clinicians consider when choosing an IPG for their patients.
Between December 2021 and June 2022, we sent a structured questionnaire with 42 questions to DBS experts of two international, functional neurosurgery societies. The questionnaire included a rating scale where participants could rate the factors influencing their choice of IPG type and their satisfaction with certain IPG aspects. Additionally, we presented four clinical case scenarios to assess preference of choice of IPG-type in each case.
Eighty-seven participants from 30 different countries completed the questionnaire. The three most relevant factors for IPG choice were "existing social support," "cognitive status," and "patient age." Most participants believed that patients valued avoiding repetitive replacement surgeries more than the burden of regularly recharging the IPG. Participants reported that they implanted the same amount of rechargeable as non-rechargeable IPGs for primary DBS insertions and 20% converted non-rechargeable to rechargeable IPGs during IPG replacements. Most participants estimated that rechargeable was the more cost-effective option.
This present study shows that the decision-making of the choice of IPG is very individualized. We identified the key factors influencing the physician's choice of IPG. Compared to patient-centric studies, clinicians may value different aspects. Therefore, clinicians should rely not only on their opinion but also counsel patients on different types of IPGs and consider the patient's preferences. Uniform global guidelines on IPG choice may not represent regional or national differences in the healthcare systems.
脑深部电刺激（DBS）治疗的成功取决于多个因素，包括合适的患者选择、精确的电极植入以及适当的刺激参数设置。另一个可能影响长期满意度和治疗效果的因素是所使用的植入式脉冲发生器（IPG）类型：可充电式或不可充电式。然而，目前对于IPG类型的选择尚无指导原则。本研究调查了DBS临床医生在为患者选择IPG时的当前做法、观点以及考虑的因素。
在2021年12月至2022年6月期间，我们向两个国际功能性神经外科学会的DBS专家发送了一份包含42个问题的结构化问卷。问卷包括一个评分量表，参与者可对影响其IPG类型选择的因素以及对某些IPG方面的满意度进行评分。此外，我们还给出了四个临床病例场景，以评估每种情况下对IPG类型的选择偏好。
来自30个不同国家的87名参与者完成了问卷。选择IPG的三个最相关因素是“现有的社会支持”、“认知状态”和“患者年龄”。大多数参与者认为，患者更看重避免重复性的更换手术，而不是定期为IPG充电的负担。参与者报告称，在初次DBS植入时，他们植入的可充电式IPG和不可充电式IPG数量相同，在更换IPG期间，20%的人将不可充电式IPG转换为可充电式IPG。大多数参与者估计可充电式是更具成本效益的选择。
本研究表明，IPG选择的决策非常个体化。我们确定了影响医生选择IPG的关键因素。与以患者为中心的研究相比，临床医生可能看重不同的方面。因此，临床医生不仅应依靠自己的意见，还应就不同类型的IPG向患者提供咨询，并考虑患者的偏好。关于IPG选择的统一全球指南可能无法体现医疗保健系统中的地区或国家差异。
