Objective: To evaluate battery life in patients managed with unilateral or bilateral subthalamic nucleus (STN) interleaved deep brain stimulation (DBS)

Background: DBS is a common surgical treatment for patients with Parkinson disease (PD), and interleaved stimulation (ILS) is a relatively new technique that involves alternating programs on the same lead, with a goal of optimizing symptom control and minimizing adverse effects. While ILS has been evaluated for efficacy and tolerability in small populations, it is unclear what effects this programming may have on battery life, as there are several theoretical concerns about increased consumption. Increasing frequency of battery replacements may subsequently increase morbidity and procedural costs. 

Methods: We conducted a retrospective review of ten patients with fifteen total implanted leads treated with ILS at our institution, and evaluated the need for battery replacement. Premature replacement was defined as battery replacement prior to 36 months post-operatively. 

Results: Half of the patients (5/10) had unilateral DBS (four in the left STN and one in the right); the remaining half had bilateral STN DBS. Of fifteen total leads, eleven (73%) were set to unipolar stimulation prior to initiation of ILS. Most leads (12/15; 80%) were transitioned to ILS within six months of the initial surgery. Nine leads in six patients required premature battery replacement, while six leads in four patients did not. One patient required one lead/battery replacement due to infection, not as a direct result of battery depletion. In all other patients, charge per second (uC/s) was calculated based on the formula by Miller et. al (2016). uC/s was ≥27 in eight leads requiring premature battery replacement, while uC/s was ≤22 in the other six. At an average of 51 months of follow-up post-operatively, eleven leads in seven patients remained in ILS.

Conclusions: In ten patients with PD treated with ILS, all leads with premature battery depletion were noted to have increased total charge per second based on their final settings. As charge per second is directly related to amplitude and pulse width, these may be independent factors resulting in early battery depletion and replacement, not the use of ILS itself. In addition, ILS appears to be efficacious and well-tolerated, as the majority of patients remained on this programming even after battery replacement. 

References: Miller, JP, Eldabe S, Buchser E, et al.  Parameters of Spinal Cord Stimulation and their Role in Electrical Charge Delivery: A review.  Neuromodulation. 2016;19:373-384.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/battery-consumption-and-need-for-replacement-in-patients-with-parkinson-disease-treated-with-interleaved-deep-brain-stimulation/