Unilateral Battery Depletion in Parkinson’s Disease Patients Treated with Bilateral Subthalamic Nucleus Deep Brain Stimulation May Require Urgent Surgical Replacement

Chou, Kelvin L.; Siderowf, Andrew; Jaggi, Jurg L.; Liang, Grace; Baltuch, Gordon H.

doi:10.1159/000081348

Cited by 19 publications

(12 citation statements)

References 12 publications

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“…The mean age of children at the time of surgery was 11.1 years (range 3. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. A diagnosis of primary dystonia had been made in 13 children, of secondary dystonia in 30 children and neuronal degeneration with brain iron accumulation (NBIA) in the remaining 11 children.…”

Section: Methodsmentioning

confidence: 99%

“…This necessitates periodic surgical replacement, exposing the patient to the attendant risks this entails. IPG replacement may also lead to a loss of stability of symptom control, with the gradual loss of even unilateral battery power potentially resulting in a gradual worsening of disabling symptoms [1,8]. In the adult setting, battery lifetimes of around 4 years have been reported in the treatment of Parkinson's disease (PD) [5,17].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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“…These calculations, however, are quite tedious and time-consuming as stimulation parameters are frequently changed over time to titrate to changing or worsening symptoms, rendering available longevity calculations useless for routine clinical use. Thus, it is imperative that battery supply voltages be periodically monitored to prevent battery failures and related morbidity [6] . To our knowledge, there are no published recommendations for the critical battery voltage at which an immediate device replacement is required.…”

Section: Introductionmentioning

confidence: 99%

Longevity Analysis of Currently Available Deep Brain Stimulation Devices

Halpern¹,

McGill²,

Baltuch³

et al. 2010

Stereotact Funct Neurosurg

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Objective: There continues to be debate about the surgical technique, electrophysiology, and hardware used in deep brain stimulation (DBS), despite its widespread use in medically intractable Parkinson’s disease and essential tremor. This article is the first, to our knowledge, to compare the longevity of the available internal pulse generators (IPGs) of DBS (Kinetra and Soletra, Medtronics). Methods: We compared the elapsed time from the initial surgery to the first replacement of IPGs in patients with bilateral Soletra IPGs to those with the unilateral Kinetra IPG and analyzed the various stimulation parameters of each device. Results: The battery life of the Soletra system was significantly longer than that of the Kinetra and also allowed for higher voltages, longer use of monopolar mode, and a greater number of electrode contacts. Conclusions: Our findings support superior battery life and a greater capacity for titration to symptom control with bilateral Soletra IPGs.

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“…As medications are reduced on average by about 40% after effective subthalamic DBS treatment for PD, 8 the likelihood of acute discomfort is high in PD patients who abruptly have DBS discontinued. 9 In our experience, a PD patient may require up to an hour to regain the ability to walk safely after 30 minutes off DBS. Longer-term studies such as overnight polysomnography may become both extremely uncomfortable for the patient and of questionable validity due to the dramatic deterioration of the motor status of the patient.…”

Section: Methodsmentioning

confidence: 84%

An MRI view of a ruptured dermoid cyst

Ernemann¹,

Rieger²,

Tatagiba³

et al. 2006

Neurology

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Abstract-As the population of patients treated with deep brain stimulation (DBS) grows and the patients age, more will require routine or emergent electrophysiologic tests. DBS artifact may render these uninterpretable, whereas stopping DBS may release symptoms that confound evaluation. The authors find that monopolar, but not bipolar, stimulation produces significant artifact during EKG, EEG, and polysomnography. NEUROLOGY 2006;66:268-270 6 Because of the growing prevalence of DBS and the aging of patients with DBS, more will require electrodiagnostic procedures (such as EKG, EEG, and polysomnography) for evaluation of acute or chronic disease. DBS generates electrical artifact, a confounder that may obscure important diagnostic information. It was recently shown that bipolar DBS produces far less electrical artifact than monopolar DBS in EKG. 7 The purpose of our investigation is to confirm these earlier findings and to compare artifact produced from bipolar and monopolar DBS in routine EKG, EEG, and PSG studies. Methods.Subjects. Subject A. A 67-year-old man with bilateral subthalamic nucleus (STN) DBS for tremor-dominant PD underwent voluntary EKG and EEG. The DBS electrodes (Medtronic model 3389) were connected to subclavicular pulse generators (Medtronic, Soletra). He was initially treated with monopolar configurations, but programming sessions over the next 2 years yielded optimal clinical effects with bipolar settings: 4.3 V, 160 Hz, contacts 3ϩ, 0Ϫ, pulse width 90 microseconds (right) and 120 microseconds (left).Following informed consent, standard EKG and EEG were obtained initially at baseline bipolar DBS settings (figures 1A and 2A), with DBS off (see figures 1B and 2B), followed by a monopolar configuration (0Ϫ, caseϩ, 3.0 V) (see figures 1C and 2C).Subject B. A 66-year-old man was treated effectively with a right thalamotomy and a left ventralis intermedius thalamic DBS for tremor. He developed postoperative hypervigilance that evolved into excessive daytime sleepiness and fractionated sleep.He was prepared for overnight polysomnography by setting DBS to a bipolar configuration (3ϩ, 0Ϫ, 120 microseconds, 160 Hz, 5.3 V).Results. Figure 1A shows the V2 lead trace clipped from the standard 12-lead EKG recorded during bipolar stimulation (see figure 1B during temporary discontinuation of DBS and figure 1C during monopolar stimulation). The bipolar configuration produced clinically insignificant artifact (see figure 1A) that was similar to the "DBS off" condition (see figure 1B). In contrast, monopolar settings produced a large-amplitude artifact on EKG that obscured the P and T waves and QRS complex on all leads, rendering the study uninterpretable (see figure 1C). Figure 2 shows samples of optimal, occipital wakeful EEG rhythm. The montage included channels with both long and short interelectrode distances. The EEG demonstrated interpretable signal during bipolar stimulation (see figure 2A) with minimal differences between bipolar mode and DBS off (see figure 2, A and B). Resting tremor was visibl...

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Unilateral Battery Depletion in Parkinson’s Disease Patients Treated with Bilateral Subthalamic Nucleus Deep Brain Stimulation May Require Urgent Surgical Replacement

Cited by 19 publications

References 12 publications

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

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

Longevity Analysis of Currently Available Deep Brain Stimulation Devices

An MRI view of a ruptured dermoid cyst

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