Fixed-Life or Rechargeable Battery for Deep Brain Stimulation: A Prospective Long-Term Study of Patient’s Preferences

Abstract

<b><i>Introduction:</i></b> Deep brain stimulation (DBS) is an established treatment for movement disorders. We have previously shown that in our practice, the majority of adult patients prefer fixed-life implantable pulse generators (IPGs), although rechargeable batteries are increasingly used. The aim of this study was to evaluate patients’ long-term satisfaction with their choice of battery and factors that influence their decision. <b><i>Methods:</i></b> Thirty patients with DBS were given a questionnaire to assess long-term satisfaction and experience with the type of battery they had chosen. <b><i>Results:</i></b> Twenty-six patients completed the survey. The mean age was 67.7 ± 7.3 years, and mean follow-up was 18.0 ± 7.2 months. The indications for DBS were Parkinson’s disease (76.9%), tremor (11.5%) and dystonia (11.5%). Eleven patients (42.5%) had chosen the rechargeable battery. All patients were still happy with their choices and would not change the type of battery if they had the chance to do so. However, in patients who chose the fixed-life battery, concern about the size of battery rose from 6.7% pre-operatively to 60% on long-term post-operative follow-up. In patients who chose the rechargeable battery, concern about the need to recharge the battery did not change, remaining low postoperatively. Interestingly, even though the main reason cited for choosing the fixed-life battery was the convenience and concern about forgetting to recharge the battery, patients who had chosen a rechargeable IPG did not experience this problem. <b><i>Conclusion:</i></b> Patients and caregivers should be involved in the choice of battery, as each type of IPG has its own advantages and disadvantages. Long-term evaluation of patient’s experience and satisfaction with battery of choice revealed that size of the IPG, need for further replacement surgeries and need for recharging remain matters of major concern. Although preoperatively often underestimated, the size of the battery seems to be an important factor in long-term satisfaction.

Fixed-Life or Rechargeable Batteries for Deep Brain Stimulation: Preference and Satisfaction Among Patients With Hyperkinetic Movement Disorders

“…Furlanetti et al reported that the main reasons for choosing the nr-IPG were convenience and concern about forgetting to recharge; however, patients using r-IPG did not report experiencing this problem (18). In our study, the main reason for choosing an nr-IPG was the economic cost (92% of patients with nr-IPGs and 62% of patients with r-IPGs).…”

Fixed-Life or Rechargeable Battery for Deep Brain Stimulation: Preference and Satisfaction in Chinese Patients With Parkinson's Disease

“…Most studies have focused on DBS safety and efficacy, but the patient's perspective on the DBS treatment delivered and the reasons for choosing or accepting a specific DBS system remain an important but under-recognized topic. For example, only a few studies performed in Europe have demonstrated that patients with PD preferred rechargeable IPG batteries over fixed-life batteries (7)(8)(9). This situation is problematic because patient preference and satisfaction are important for treatment acceptance, treatment compliance, and the further development of next generation of DBS systems.…”

Choice of Implantable Pulse Generators for Deep Brain Stimulation: An Overview of Clinical Practice

“…The size of the non-rechargeable IPG showed a lower score on satisfaction than the size of the rechargeable IPG. Furlanetti et al [10] concluded that the concern about IPG size in patients that received a non-rechargeable IPG rose from 6.7% preoperatively to 60% on long-term postoperative follow-up. Size could be a determining factor, especially in patients with IPG discomfort, pocket pain, or low BMI.…”

“…Another important factor in the choice of IPG may be national or center-specific agreements on reimbursement [9]. Besides financial and technical reasons, motor and cognitive functions, patient capability to monitor and operate the device, the size of the IPG [10], and patient preference may be determining factors. The complexity of IPG choice is increased further by combining implants from different medical device manufacturers to enable new stimulation options with already implanted DBS electrodes by creating so-called hybrid DBS systems [11,12].…”