Battery life following pallidal deep brain stimulation (DBS) in children and young people with severe primary and secondary dystonia

Lumsden, Daniel E.; Kaminska, Margaret; Tustin, Kylie; Gimeno, Hortensia; Baker, Lesley; Ashkan, Keyoumars; Selway, Richard; Lin, Jean-Pierre

doi:10.1007/s00381-012-1728-6

Cited by 34 publications

(27 citation statements)

References 23 publications

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“…patients, and to reduce the frequency of battery replacement 32 . Increased risk of implant infection related to higher number of surgical revisions, including IPG replacement, has been reported 33 34 .…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Complications of Deep Brain Stimulation (DBS) for dystonia in children – The challenges and 10 year experience in a large paediatric cohort

Kaminska

Perides

Lumsden

et al. 2017

European Journal of Paediatric Neurology

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Please cite this article as: Kaminska M, Perides S, Lumsden DE, Nakou V, Selway R, Ashkan K, Lin J-P, Complications of Deep Brain Stimulation (DBS) for dystonia in children -the challenges and 10 year experience in a large paediatric cohort, European Journal of Paediatric Neurology (2016Neurology ( ), doi: 10.1016Neurology ( / j.ejpn.2016 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. • Lower than previously reported infection rates following DBS for movement disorders in children were identified and no increased susceptibility for patients younger than 7 years. • We report relatively high incidence of technical problems with electrodes and extensions and in particular recharging.• Presentation of heterogeneous phenotypes requires an experienced team to manage and prevent complications. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPTThe paper confirms that DBS in young children is safe and can be offered. Abstract:Deep brain stimulation (DBS) has been increasingly used for primary and secondary movement disorders in children and young people. Reports of hardware related complications have been sparse for this population and from small cohorts of patients.We report DBS complications from a single large DBS centre with 10 year experience.Data was collected as a prospective audit and additionally from a questionnaire on recharging of the stimulators. 129 patients with a minimum 6 months follow up were identified, mean age10.8 y (range 3.0 -18.75), mean follow up 3.3y (range 0.5 -10.3), weight 10.4-94.2kg, 126 new implants (92 Activa RC) and 69 revisions for reasons other than infection. 26 patients were 7y or younger. Surgical site infections (SSI) rates were 10.3% for new implants and revisions, lower 8.6% for new Activa RC and even lower, 4.7%, for new Activa RC in patients under 7y (1/21). SSI occurred within first 6 months and necessitated total system removal in 86% of those infected. Electrode/extension problems were recorded in 18.4% of patients, fracture in 4.6% malfunction in 7.7%, short extension3.8% and electrode migration in 2.3%. Other complications involved clinically silent intracranial bleed in 1 patient, skin erosions (2.3%), unexpected switching off in 18.7% of Soletra/Kinetra and 3.4% of Activa RC, transient seroma at IPG site in postoperative period (8%). Of the 48 returned recharging questionnaires, 38% of families required recharger replacement and 23% experienced frequent problems maintaining connection during recharging. However, 83% of responders considered recharging not at all or only a little care burden.We identified lower than previously reported DBS infection rates ...

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Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Complications of Deep Brain Stimulation (DBS) for dystonia in children – The challenges and 10 year experience in a large paediatric cohort

Kaminska

Perides

Lumsden

et al. 2017

European Journal of Paediatric Neurology

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“…The Activa RC has the advantage of reducing both the number of battery changes needed and the associated potential complications [14] . The cases described here, however, indicate an unreported hardware complication of DBS when replacing non-rechargeable IPGs with rechargeable ones using an adaptor.…”

Section: Discussionmentioning

confidence: 99%

“…The traditional implanted pulse generators (IPGs) have a battery life typically of 1.5-8 years [12,13] , after which they have to be replaced surgically [14] .…”

Section: Introductionmentioning

confidence: 99%

Shielded Battery Syndrome: A New Hardware Complication of Deep Brain Stimulation

Chelvarajah

Lumsden²,

Kaminska³

et al. 2012

Stereotact Funct Neurosurg

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Background: Deep brain stimulation hardware is constantly advancing. The last few years have seen the introduction of rechargeable cell technology into the implanted pulse generator design, allowing for longer battery life and fewer replacement operations. The Medtronic® system requires an additional pocket adaptor when revising a non-rechargeable battery such as their Kinetra® to their rechargeable Activa® RC. This additional hardware item can, if it migrates superficially, become an impediment to the recharging of the battery and negate the intended technological advance. Aim: To report the emergence of the ‘shielded battery syndrome’, which has not been previously described. Methods: We reviewed our deep brain stimulation database to identify cases of recharging difficulties reported by patients with Activa RC implanted pulse generators. Results: Two cases of shielded battery syndrome were identified. The first required surgery to reposition the adaptor to the deep aspect of the subcutaneous pocket. In the second case, it was possible to perform external manual manipulation to restore the adaptor to its original position deep to the battery. Conclusions: We describe strategies to minimise the occurrence of the shielded battery syndrome and advise vigilance in all patients who experience difficulty with recharging after replacement surgery of this type for the implanted pulse generator.

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“…A challenge with DBS for dystonia is the relatively fast rate of battery depletion in patients who generally require high settings to control their symptoms [78,79]. Rechargeable neurostimulators may be a reasonable option for these patients and eliminate the need for replacement batteries every few years [80,81].…”

Section: Surgical Treatmentsmentioning

confidence: 99%

Treatment of Dystonia

Thenganatt

Jankovic

2014

Neurotherapeutics

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Selecting the appropriate treatment for dystonia begins with proper classification of disease based on age, distribution, and underlying etiology. The therapies available for dystonia include oral medications, botulinum toxin, and surgical procedures. Oral medications are generally reserved for generalized and segmental dystonia. Botulinum toxin revolutionized the treatment of focal dystonia when it was introduced for therapeutic purposes in the 1980s. Surgical procedures are available for medication-refractory dystonia, markedly affecting an individual's quality of life.

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Battery life following pallidal deep brain stimulation (DBS) in children and young people with severe primary and secondary dystonia

Abstract: IPG battery life may be short in children and young people receiving treatment for dystonia. These findings highlight the potential benefits of the recently introduced rechargeable neurostimulators.

Cited by 34 publications

References 23 publications

Complications of Deep Brain Stimulation (DBS) for dystonia in children – The challenges and 10 year experience in a large paediatric cohort

Complications of Deep Brain Stimulation (DBS) for dystonia in children – The challenges and 10 year experience in a large paediatric cohort

Shielded Battery Syndrome: A New Hardware Complication of Deep Brain Stimulation

Treatment of Dystonia

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