Artikel
RechargePSYCH – rechargeable implantable pulse generators in patients with deep brain stimulation for psychiatric disorders
RechargePSYCH – wiederaufladbare implantierbare Pulsgeneratoren bei Patienten mit Tiefer Hirnstimulation zur Behandlung psychiatrischer Erkrankungen
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Autoren
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Martin Jakobs
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Andres M. Lozano
- University Health Network, Toronto, Division of Neurosurgery, Toronto, Kanada
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David Hernán Aguirre-Padilla
- University of Chile, Department of Neurology and Neurosurgery, Santiago de Chile, Chile
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Peter Giacobbe
- Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Kanada
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Andreas W. Unterberg
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: The effects of Deep Brain Stimulation (DBS) for different psychiatric disorders have been explored in clinical trials. Implantable pulse generator (IPGs) replacements represent the most common type of scheduled follow-up surgeries as stimulation parameters are usually higher compared to movement disorder patients. Rechargeable IPGs offer longer battery life causing fewer surgical replacements combined with a smaller implant size. The impact of this technology on psychiatric patients as well as the amount of time necessary to maintain therapy are still unknown.
Methods: A single center database analysis was performed to identify all DBS patients who were implanted with a rechargeable IPG for a psychiatric indication from 2003 to 2019. Patients that were still implanted with a rechargeable device at the time of the trial were asked to complete a standardized online questionnaire. Primary endpoint was the rating of the convenience of recharging of the entire process and each individual step on an ordinal scale (0-10). Secondary endpoints were the rate of user confidence, user satisfaction, complications (failed recharges, interruptions of therapy) and the charge burden (minutes per week necessary to recharge the IPG).
These endpoints were tested for differences in several subgroups (age, sex, indication, IPG model, confidence).
Results: N=21 patients completed the questionnaire including n=13 patients with major depression, n=6 patients with anorexia and n=2 patients with OCD. Mean age was 50.7 years with an average time of therapy with the rechargeable IPG of 31.8 months. Patients had undergone a median of 3 IPG replacements before receiving the rechargeable IPG.
Convenience of recharging was rated high (8.0 out of 10.0 points).
The mean charge burden was 286 minutes, which was regarded as acceptable by only 43% of patients.
81% of patients felt confident using the device. 66.7% would recommend and 62% would choose a rechargeable IPG again. 33% of patients experienced a failed recharge and 38% had an unintentional interruption of therapy.
Depression patients rated the convenience of recharging significantly worse compared to OCD patients (p=0.027). Patients that did not feel confident were less likely to recommend (p=0.006) or choose a rechargeable IPG again (p=0.012).
Conclusion: Rechargeable IPGs can be safely implanted in DBS patients with psychiatric indications. Charge burden and complication rates are higher compared to movement disorder patients.
