Objective: Deep brain stimulation (DBS) is an efficient treatment modality for Parkinson’s Disease (PD), essential tremor and dystonia. Differing from the Constant Voltage-(CV)-DBS devices, Constant Current (CC)-DBS devices may allow more precise stimulation of the target brain regions since they are lesser influenced by impedance. If IPGs (Internal Pulse Generators) of DBS-devices are required to be connected with electrodes of different brands, employing proper adapters are necessary. Such connected DBS-devices are called as mixed or hybrid devices. As there exists sparse information about the clinical utility of mixed devices, we aimed to study the efficacy, safety and satisfaction issues of patients implanted with mixed DBS-devices

Background: Various centers have shared their experiences about the compatibility of electrodes and batteries of different brands with adapter support in these mixed devices. Nonetheless, sufficient information lacks about the reliability of these mixed devices and the regulation in programming. Few publications exist in the literature on mixed implants switched from CV to CC in DBS.

Method: Clinical scores of 13 patients implanted with mixed DBS-devices were determined with UPDRS – Unified Parkinson’s Disease Rating Scale in PD (n=10) and with BFMDRS – Burke-Fahn-Marsden Dystonia Rating Scales in dystonia (n=3). Patient satisfaction was assessed with the Timmerman questionnaire. The clinical global impression improvement scale (CGI-I) was also evaluated.

Results: According to Timmerman survey, the patients’ overall satisfaction was considerably high with mixed devices.(Figure 1,Table 1-2) The UPDRS and BFMDRS clinical scores did not significantly differ after switch to a mixed DBS-device. Three patients before the DBS-switch suffered from side effects under the CV mode. One had dysarthria, one had minimal arm contraction and the last one suffered from paresthesia in arm. (Table 3)These patients got rid of the side effects in their follow-up with reduction of the pulse width values which led to slight improvements in CGI-I scores.

Conclusion: Mixed devices working in CC-mode are well tolerated with high patient satisfaction and may ameliorate undesirable clinical effects encountered with DBS-devices working in CV-mode.

References: Preda F, Cavandoli C, Lettieri C, Pilleri M, Antonini A, Eleopra R, Mondani M, Martinuzzi A, Sarubbo S, Ghisellini G, Trezza A, Cavallo MA, Landi A, Sensi M. Switching from constant voltage to constant current in deep brain stimulation: a multicenter experience of mixed implants for movement disorders. Eur J Neurol. 2016 Jan;23(1):190-5. doi: 10.1111/ene.12835

Wolf ME, Klockziem M, Majewski O, Schulte DM, Krauss JK, Blahak C. Implementation of New Technology in Patients with Chronic Deep Brain Stimulation: Switching from Non-Rechargeable Constant Voltage to Rechargeable Constant Current Stimulation. Stereotact Funct Neurosurg. 2019;97(5-6):362-368. doi: 10.1159/000505076

Soh D, Lozano AM, Fasano A. Hybrid deep brain stimulation system to manage stimulation-induced side effects in essential tremor patients. Parkinsonism Relat Disord. 2019 Jan;58:85-86. doi: 10.1016/j.parkreldis.2018.07.013

Wirth T, Laurencin C, Berthillier J, Brinzeu A, Polo G, Simon E, Mertens P, Broussolle E, Danaila T, Thobois S. Feasibility of changing for a rechargeable constant current neurostimulator in Parkinson’s disease. Rev Neurol (Paris). 2021 Mar;177(3):283-289. doi: 10.1016/j.neurol.2020.02.007

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MDS Abstracts - https://www.mdsabstracts.org/abstract/is-it-safe-to-switch-from-constant-voltage-to-constant-current-with-a-mixed-internal-pulse-generator-in-deep-brain-stimulation/