How to avoid trivial mistakes during IPG replacement in patients treated with DBS for movement disorders: technical note from 13-years experience

Abstract

Our surgical and postoperative management demonstrates how to avoid some important adverse events with some easy steps, without any discomfort for the patients in terms of duration of surgery or longer hospitalization. Thus, stability of symptoms after the IPG replacement may be easily guaranteed during the first postoperative period.

Rechargeable Internal Pulse Generators as Initial Neurostimulators for Deep Brain Stimulation in Patients With Movement Disorders

“…The power source for this continuous stimulation is an implantable pulse generator (IPG) that resembles a cardiac pacemaker in size and technology. As the energy consumption in constant DBS is high, battery depletion is the most common cause for further surgery in DBS patients. Although an IPG exchange is a minor surgical procedure compared to the primary operation, it has specific risks.…”

Is capsulectomy a feasible and useful measure in internal pulse generator replacement procedures? A technical note on the use of the PEAK PlasmaBladeTM

“…Adverse events, such as extension cable damage or an IPG pocket infection, can indeed dramatically affect a patient's quality of life because of a subsequent therapeutic stimulation outage [11]. Moreover, it seems that adverse events related to the surgical technique occur more frequently in IPG replacement than in primary DBS lead implantation, as observed in many secondary infection studies [6,9].…”

“…Current consumption is related to the features of each specific disease though; for instance, in dystonic patients it is greater than in those with Parkinson's disease (PD) and essential tremor (ET) [3,6,11]. IPG replacements are frequently performed in functional neurosurgery units, mostly because the vast majority of implanted devices are not rechargeable, and demand will significantly increase within the next decades.…”

Preliminary Experience with a Four-Lead Implantable Pulse Generator for Deep Brain Stimulation

“…However, a disadvantage is an infection of the 4-port IPG could lead to explantation of all leads, whereas one IPG and its associated leads may be saved if two IPGs are utilized. Furthermore, non-rechargeable systems require surgical replacement, and the battery lifetime can be as low as a few years depending on power usage [36]. The device evaluated in this report has been rated for a 15/25-year lifespan by the FDA/EMA.…”