Is a Patient Controller for Parkinson’s Disease Patients with Subthalamic Nucleus Deep Brain Stimulation Reasonable?

Abstract

Background: A patient controller (PC) is an optional device for patients with deep brain stimulation (DBS) to have limited control of their stimulator system. Objectives: We investigated the impact of a PC on DBS safety, most notably the handling/prevention of unexpected DBS failure in patients with Parkinson’s disease (PD). Methods: PD patients with subthalamic DBS were educated in the use of a PC. After a first impulse generator (IPG) replacement, data on the use of the PC were obtained from the patients’ records and by a patient questionnaire. Results: A total of 27 patients with IPG replacements after 4.4 ± 0.8 years (118.8 patient-years) were included. Thirteen patients transiently used the PC to optimize stimulation amplitudes. Eighteen patients reported events when they used the PC to ensure DBS being on. No accidental switch off by environmental electromagnetism was confirmed. In contrast, 4 patients accidentally turned the IPG off with the PC. Sixteen patients regularly checked the IPG battery but only 1 patient noted a low battery status before quarterly control visits. Of the 27 patients, 26 had anticipated and only 1 an unanticipated IPG replacement. Conclusions: A PC is not needed for patient safety. However, in some patients, a PC is helpful to optimize stimulation amplitudes and to increase the patients’ own perception of safety.

Longevity of Implantable Pulse Generators in Bilateral Deep Brain Stimulation for Movement Disorders

“…Our findings were consistent with those of other authors who have already reported an inverse correlation of TEED and IPG longevity . Longevity of the Kinetra, however, was shorter in previous studies when compared to our findings. This could be due to higher stimulation settings in these studies which we could not adequately verify through the published data.…”

“…Mean longevities were 40.2–83 months in Itrel ® II (Model 7425) , 37.8 months in Itrel III (Model 7425) , 25.1–44.9 months in Soletra ® (Model 7426) , and 19.7–52.4 months in Kinetra (Model 7428) , manufactured by Medtronic (Medtronic, Inc., Minneapolis, MN, USA), respectively. However, comparison of the available data might be difficult due to the inconsistently chosen replacement indications, such as replacement before complete IPG discharge , end of life (EOL) or complete depletion , or lacking telemetry . Moreover, data on the longevity of Medtronic's latest IPG for DBS, the Activa PC (Modell 37601), is so far missing.…”

Perceptions of Living With a Device-Based Treatment: An Account of Patients Treated With Deep Brain Stimulation for Parkinson’s Disease

“…In line with that, Allert et al. reported, in 27 consecutive PD patients treated with bilateral STN DBS, a mean of 28.6 days of hospital or rehabilitation stay for programming of the IPG.…”

“…The parameter settings are highly individual and may be changed at any programming session to optimize the patient's symptom relief. Most centers provide the patient with a handheld therapy controller for home use . The controller allows the patient to switch the device on and off, as well as to increase or decrease the electric stimulation within a window of electric parameters decided by the clinician at the programming session.…”

Langzeitbehandlung von Parkinsonpatienten mit Tiefer Hirnstimulation

“…Der Magnetschalter dieser Impulsgeber kann auch von elektromagnetischen Feldern in der Umwelt aktiviert werden und so zu einem unbeabsichtigten Abschalten der THS führen. Der 2-Kanal-Impulsgeber Kinetra ® besitzt ebenfalls einen Magnet-empfindlichen Schalter (reed switch), der jedoch telemetrisch inaktiviert werden kann, sodass der Impulsgeber weitgehend unbeeinflusst von Magnetfeldern in der Umwelt ist [10]. Darüber hinaus gestattet der Kinetra ® eine grobe Kontrolle der Batteriekapazität, sodass es seltener zu einem unvorhergesehenen Batterieausfall kommt.…”