gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Criteria for implantation of a new rechargeable pulse generator for deep brain stimulation based on replacement intervals of Kinetra® devices

Meeting Abstract

  • G.H. Schneider - Klinik für Neurochirurgie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
  • L. Weise - Klinik für Neurochirurgie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
  • A. Kivi - Klinik für Neurologie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
  • A. Kühn - Klinik für Neurologie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
  • A. Abbushi - Klinik für Neurochirurgie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
  • J. Hübel - Klinik für Neurologie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
  • A. Kupsch - Klinik für Neurologie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP07-10

DOI: 10.3205/09dgnc326, URN: urn:nbn:de:0183-09dgnc3261

Published: May 20, 2009

© 2009 Schneider et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Bilateral deep brain stimulation (DBS) has been well established for various movement disorders. A decrease of the mean age of DBS-patients over time and the persisting beneficial stimulation effects will lead to an increase of replacements of stimulators after battery depletion. Additionally, the recent availability of a rechargeable stimulator for DBS necessitates the definition of indications for each stimulator type. We therefore retrospectively investigated the time periods between implantation and replacement of Kinetra® stimulators in DBS patients.

Methods: From 2000 to 2005 152 patients received bilateral stimulation of STN, GPi, or Vim for Parkinson’s disease (PD, n=91), dystonia (DY, n=44), or essential tremor (ET, n=17), respectively. 41 of these patients who underwent a replacement for low battery voltage (stimulator capacity <20%) were included in this study. Replacements due to infections or other stimulator complications as well as patients who were treated with more than two DBS leads were excluded. We correlated the periods between stimulator implantations to the aforesaid disease entities. Additional parameters to be evaluated were stimulation voltage, pulse width, and frequency as well as the number of active contacts.

Results: The mean age of PD patients was 63.9±9.3y, 52.1±15.1y for DY, and 67.1±10.0y for ET patients. The time period until replacement was shortest in DY (3.2±1.4 [1.5–5.7] y, n=19, Kinetra®). Additionally, in DY more than one replacement was necessary over the investigated period in 21%. In contrast, the stable benefit from the initial device was longest in a patient with ET, the only ET patient who needed a replacement after 6.9y during the analyzed period. The data for PD patients were intermediate (4.9±1.5 [2.1–7.3] y, n=21, Kinetra®). An inverse correlation was found between total electrical energy delivered (TEED) from the Kinetra® units and the replacement interval.

Conclusions: Our data support the assumption that future patients with DBS for dystonia will benefit most from a primary implantation of the new rechargeable stimulator, since they will not need further replacements during the life span of the rechargeable device (9y). This would probably decrease the procedure-associated incidence of risks. For younger patients with PD a rechargeable device should be considered as well, while in late septuagenarian PD patients the full working capacity of a Kinetra® might exceed the patient’s life time.