Objective: To contrast neurostimulator battery decay subsequent to the implementation of interleaving with that prior to interleaving.

Background: Neurostimulators permit “interleaving”, which allows different same-lead contacts to alternate between emitting pulses during Deep Brain Stimulation (DBS). DBS patients programmed with interleave configurations have been found to have less side effects (Ramirez-Zamora et al., 2014). Further, we demonstrated in a small Essential Tremor (ET) DBS case series that the Total Electrical Energy Delivered (TEED) interleave estimates were less than their immediate non-interleave equivalents, if the interleave frequency were halved, suggesting less battery drain (Feinstein, et al., 2015). Here, we provide clinical support for this claim by comparing battery drain, subsequent- and prior- to DBS interleaving.

Methods: We conducted a retrospective chart review of 54 patients managed in our practice who were implanted with Activa PCs for Movement Disorders, in any of the Ventral Intermediate nucleus of the Thalamus (VIM), the Globus Pallidus interna (GPi), and the subthalamic nucleus (STN) targets. All battery charge estimates prior- and subsequent- to interleave implementation had to fall within the linear portion of the overall decay curve, being less than 2.99V and greater than 2.82V (Montuno et al., 2013; Patel et al., 2015). Of the 54 charts reviewed 18 met the criteria.

Results: An average of 369 days (sem=52.3) across 4.4 visits were analyzed prior to interleave implementation, while an average of 335 days (sem=34.5) across 4.9 visits were analyzed subsequent to interleaving. The slopes of linear regressions fit to each individual’s prior- and subsequent- interleave decay curves were analyzed with paired t-tests. Overall, no differences were found between the decay slopes [t(17)=0.64; p=0.52]. However, consistent with our previous work, when the 7 cases with no substantial drop in frequency (halving) during the interleave implementation were removed, then statistically significant differences were revealed, favoring the interleaves with lessened decay slopes [t(10)=2.44; p=0.035].

Conclusions: Interleaving does not result in greater battery drain. Further, interleaving does result in lessened battery decay, when the frequency is halved during implementation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/minimal-impact-of-interleaving-on-neuromodulation-device-battery-drain-when-interleave-frequency-is-halved/