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Prenassi M, Arlotti M, Borellini L, Bocci T, Cogiamanian F, Locatelli M, Rampini P, Barbieri S, Priori A, Marceglia S. The Relationship Between Electrical Energy Delivered by Deep Brain Stimulation and Levodopa-Induced Dyskinesias in Parkinson's Disease: A Retrospective Preliminary Analysis. Front Neurol 2021; 12:643841. [PMID: 34135846 PMCID: PMC8200487 DOI: 10.3389/fneur.2021.643841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Adaptive Deep Brain Stimulation (aDBS) is now considered as a new feasible and effective paradigm to deliver DBS to patients with Parkinson's disease (PD) in such a way that not only stimulation is personalized and finely tuned to the instantaneous patient's state, but also motor improvement is obtained with a lower amount of energy transferred to the tissue. Amplitude-controlled aDBS was shown to significantly decrease the amplitude-driven total electrical energy delivered to the tissue (aTEED), an objective measure of the amount of energy transferred by DBS amplitude to the patient's brain. However, there is no direct evidence of a relationship between aTEED and the occurrence of DBS-related adverse events in humans. Objective: In this work, we investigated the correlation of aTEED with the occurrence of levodopa-induced dyskinesias pooling all the data available from our previous experiments using aDBS and cDBS. Methods: We retrospectively analyzed data coming from 19 patients with PD undergoing surgery for STN-DBS electrode positioning and participating to experiments involving cDBS and aDBS delivery. Patients were all studied some days after the surgery (acute setting). The aTEED and dyskinesia assessments (Rush Dyskinesia Rating Scale, RDRS) considered in the Med ON-Stim ON condition. Results: We confirmed both that aTEED values and RDRS were significantly lower in the aDBS than in cDBS sessions (aTEED mean value, cDBS: 0.0278 ± 0.0011 j, vs. aDBS: 0.0071 ± 0.0003 j, p < 0.0001 Wilcoxon's rank sum; normalized RDRS mean score, cDBS: 0.66 ± 0.017 vs. aDBS: 0.45 ± 0.01, p = 0.025, Wilcoxon's rank sum test). In addition, we found a direct significant correlation between aTEED and RDRS (ρ = 0.44, p = 0.0032, Spearman's correlation). Conclusions: Our results provide a first piece of evidence that aTEED is correlated to the amount of levodopa-induced dyskinesias in patients with PD undergoing STN-DBS, thus supporting the role of aDBS as feasible and safe alternative to cDBS.
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Affiliation(s)
- Marco Prenassi
- Dipartimento di Ingegneria e Architettura, Università Degli Studi di Trieste, Trieste, Italy
| | | | - Linda Borellini
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tommaso Bocci
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Milan, Italy
| | - Filippo Cogiamanian
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Locatelli
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Paolo Rampini
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sergio Barbieri
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Priori
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Milan, Italy
| | - Sara Marceglia
- Dipartimento di Ingegneria e Architettura, Università Degli Studi di Trieste, Trieste, Italy.,Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
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Benson K, McCrery R, Taylor C, Padron O, Blok B, de Wachter S, Pezzella A, Gruenenfelder J, Pakzad M, Perrouin-Verbe MA, Van Kerrebroeck P, Mangel J, Peters K, Kennelly M, Shapiro A, Lee U, Comiter C, Mueller M, Goldman H, Lane F. One-year outcomes of the ARTISAN-SNM study with the Axonics System for the treatment of urinary urgency incontinence. Neurourol Urodyn 2020; 39:1482-1488. [PMID: 32339339 PMCID: PMC7384085 DOI: 10.1002/nau.24376] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/15/2020] [Indexed: 11/10/2022]
Abstract
Aims Sacral neuromodulation (SNM) is a guideline‐recommended treatment for voiding dysfunction including urgency, urge incontinence, and nonobstructive retention as well as fecal incontinence. The Axonics® System is a miniaturized, rechargeable SNM system designed to provide therapy for at least 15 years, which is expected to significantly reduce revision surgeries as it will not require replacement as frequently as the non‐rechargeable SNM system. The ARTISAN‐SNM study is a pivotal study designed to treat patients with urinary urgency incontinence (UUI). Clinical results at 1‐year are presented. Methods A total of 129 eligible UUI patients were treated. All participants were implanted with a quadripolar tined lead and neurostimulator in a single procedure. Efficacy data were collected using a 3‐day bladder diary, a validated quality of life questionnaire (ICIQ‐OABqol), and a participant satisfaction questionnaire. Therapy responders were defined as participants with ≥50% reduction in UUI episodes compared to baseline. Data were analyzed on all 129 participants. Results At 1 year, 89% of the participants were therapy responders. The average UUI episodes per day reduced from 5.6 ± 0.3 at baseline to 1.4 ± 0.2. Participants experienced an overall clinically meaningful improvement of 34 points on the ICIQ‐OABqol questionnaire. All study participants (100%) were able to recharge their device at 1 year, and 96% of participants reported that the frequency and duration of recharging was acceptable. There were no serious device‐related adverse events. Conclusions The Axonics System is safe and effective at 1 year, with 89% of participants experiencing clinically and statistically significant improvements in UUI symptoms.
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Affiliation(s)
| | - Rebecca McCrery
- Adult and Pediatric Urology and Urogynecology, Omaha, Nebraska
| | | | | | - Bertil Blok
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Stefan de Wachter
- Department of Urology, University Hospital Antwerpen, Edegem, Belgium
| | | | | | - Mahreen Pakzad
- Department of Urology, University College London Hospital, Marylebone, London, UK
| | | | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | | | - Andrew Shapiro
- Chesapeake Urology Research Associates, Owings Mills, Maryland
| | - Una Lee
- Virginia Mason, Seattle, Washington
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Blok B, Van Kerrebroeck P, de Wachter S, Ruffion A, Van der Aa F, Perrouin-Verbe MA, Elneil S. Two-year safety and efficacy outcomes for the treatment of overactive bladder using a long-lived rechargeable sacral neuromodulation system. Neurourol Urodyn 2020; 39:1108-1114. [PMID: 32243625 PMCID: PMC7217215 DOI: 10.1002/nau.24317] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/23/2020] [Indexed: 02/03/2023]
Abstract
AIMS Sacral neuromodulation (SNM) therapy for overactive bladder (OAB) has proven long-term safety and efficacy. Historically, the only commercially available SNM device was nonrechargeable requiring replacement surgery due to battery depletion. The Axonics System is the first rechargeable SNM device and is qualified to last a minimum of 15 years in the body. The study objective was to evaluate the safety and efficacy of this rechargeable SNM system. This study reports 2-year outcomes. METHODS A total of 51 subjects were implanted with the Axonics System in a single nonstaged procedure. Subjects had OAB, confirmed on a 3-day voiding diary (≥8 voids/day and/or ≥2 incontinence episodes over 72 hours). Test Responders were defined as subjects that were responders at 1 month postimplant. The efficacy analysis included therapy responder rates, change in the quality of life, and subject satisfaction reported in Test Responders (n = 30) and all implanted subjects (n = 37) that completed the follow-up visits. Adverse events (AEs) are reported in all implanted subjects. RESULTS At 2 years, 90% of the Test Responders continued to respond to the therapy based on voiding diary criteria. Satisfaction with therapy was reported by 93% of subjects and 86% found their charging experience acceptable. Of the urinary incontinence Test Responders, 88% continued to be responders at 2 years, and 28% were completely dry. There were no unanticipated (AEs) or serious device-related AEs. CONCLUSIONS The Axonics System® provides sustained clinically meaningful improvements in OAB subjects at 2 years. There were no serious device-related AEs. Subjects reported continued satisfaction with their therapy.
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Affiliation(s)
- Bertil Blok
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Alain Ruffion
- Department of Urology, Hôpital Lyon Sud, Lyon, Pierre Bénite, France
| | | | | | - Sohier Elneil
- Department of Uro-Neurology, National Hospital of Neurology and Neurosurgery, London, UK
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Hitti FL, Vaughan KA, Ramayya AG, McShane BJ, Baltuch GH. Reduced long-term cost and increased patient satisfaction with rechargeable implantable pulse generators for deep brain stimulation. J Neurosurg 2019; 131:799-806. [PMID: 30265199 DOI: 10.3171/2018.4.jns172995] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) has revolutionized the treatment of neurological disease, but its therapeutic efficacy is limited by the lifetime of the implantable pulse generator (IPG) batteries. At the end of the battery life, IPG replacement surgery is required. New IPGs with rechargeable batteries (RC-IPGs) have recently been introduced and allow for decreased reoperation rates for IPG replacements. The authors aimed to examine the merits and limitations of these devices. METHODS The authors reviewed the medical records of patients who underwent DBS implantation at their institution. RC-IPGs were placed either during initial DBS implantation or during an IPG change. A cost analysis was performed that compared RC-IPGs with standard IPGs, and telephone patient surveys were conducted to assess patient satisfaction. RESULTS The authors identified 206 consecutive patients from 2011 to 2016 who underwent RC-IPG placement (mean age 61 years; 67 women, 33%). Parkinson's disease was the most common indication for DBS (n = 144, 70%), followed by essential tremor (n = 41, 20%), dystonia (n = 13, 6%), depression (n = 5, 2%), multiple sclerosis tremor (n = 2, 1%), and epilepsy (n = 1, 0.5%). DBS leads were typically placed bilaterally (n = 192, 93%) and targeted the subthalamic nucleus (n = 136, 66%), ventral intermediate nucleus of the thalamus (n = 43, 21%), internal globus pallidus (n = 21, 10%), ventral striatum (n = 5, 2%), or anterior nucleus of the thalamus (n = 1, 0.5%). RC-IPGs were inserted at initial DBS implantation in 123 patients (60%), while 83 patients (40%) were converted to RC-IPGs during an IPG replacement surgery. The authors found that RC-IPG implantation resulted in $60,900 of cost savings over the course of 9 years. Furthermore, patient satisfaction was high with RC-IPG implantation. Overall, 87.3% of patients who responded to the survey were satisfied with their device, and only 6.7% found the rechargeable component difficult to use. In patients who were switched from a standard IPG to RC-IPG, the majority who responded (70.3%) preferred the rechargeable IPG. CONCLUSIONS RC-IPGs can provide DBS patients with long-term therapeutic benefit while minimizing the need for battery replacement surgery. The authors have implanted rechargeable stimulators in 206 patients undergoing DBS surgery, and here they demonstrate the cost-effectiveness and high patient satisfaction associated with this procedure.
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Niemann M, Schneider GH, Kühn A, Vajkoczy P, Faust K. Clinical Efficacy of Bilateral Deep Brain Stimulation Does Not Change After Implantable Pulse Generator Replacement but the Impedances Do: A Prospective Study. Neuromodulation 2019; 23:530-536. [PMID: 31323173 DOI: 10.1111/ner.13022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 05/13/2019] [Accepted: 06/12/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is an approved therapy option for movement disorders such as Parkinson's disease (PD), essential Tremor (ET), and dystonia. While current research focuses on rechargeable implantable pulse generators (IPGs), little is known about changes of the motor functions after IPG replacement and the consequences of additionally implanted hardware. OBJECTIVE To assess changes of the motor functions, the therapy impedances, and the total electric energy delivered (TEED) after elective IPG replacement. METHODS We prospectively acquired the data of 47 patients with PD, ET, and dystonia treated with bilateral DBS. Motor functions were rated prior to and after surgery using the revised Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III), the Fahn-Tolosa-Marin Tremor-Rating-Scale (FTM-TRS), and the Unified Dystonia Rating Scale (UDRS). Furthermore, the therapy impedances and TEED were assessed at the aforementioned times. RESULTS While preoperative motor scores were 48.32 ± 17.16 in PD, 39.71 ± 12.28 in ET, and 18.48 ± 16.30 in dystonia patients, postoperative scores were 47.84 ± 24.33, 32.86 ± 15.82, and 15.02 ± 15.17, respectively. Only in dystonia patients, motor scores significantly differed. Perioperative therapy impedance changes were 142.66 ± 105.35 Ω (Kinetra® to Activa® PC), -68.75 ± 43.05 Ω (Activa® PC to Activa® PC), and - 51.38 ± 38.75 Ω (Activa® PC to Activa® RC). Perioperative TEED changes were - 37.15 ± 38.87 μJ, 2.03 ± 35.91 μJ, and 12.39 ± 6.31 μJ in that first, second, and third group, respectively. Both the therapy impedances and TEED significantly differed between groups. CONCLUSION Although there were no statistically significant changes in the motor functions of all patients after elective IPG replacement, the therapy impedances were significantly higher and TEED was significantly lower after IPG replacement with concurrent Pocket Adapter implantation.
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Affiliation(s)
- Marcel Niemann
- Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany
| | | | - Andrea Kühn
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany
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6
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Mitchell KT, Volz M, Lee A, San Luciano M, Wang S, Starr PA, Larson P, Galifianakis NB, Ostrem JL. Patient Experience with Rechargeable Implantable Pulse Generator Deep Brain Stimulation for Movement Disorders. Stereotact Funct Neurosurg 2019; 97:113-119. [PMID: 31288242 DOI: 10.1159/000500993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 05/08/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Nonrechargeable deep brain stimulation implantable pulse generators (IPGs) for movement disorders require surgical replacement every few years due to battery depletion. Rechargeable IPGs reduce frequency of replacement surgeries and inherent risks of complications but require frequent recharging. Here, we evaluate patient experience with rechargeable IPGs and define predictive characteristics for higher satisfaction. METHODS We contacted all patients implanted with rechargeable IPGs at a single center in a survey-based study. We analyzed patient satisfaction with respect to age, diagnosis, target, charging duration, and body mass index. We tabulated hardware-related adverse events. RESULTS Dystonia patients had significantly higher satisfaction than Parkinson's disease patients in recharging, display, programmer, and training domains. Common positive responses were "fewer surgeries" and "small size." Common negative responses were "difficulty finding the right position to recharge" and "need to recharge every day." Hardware-related adverse events occurred in 21 of 59 participants. CONCLUSION Patient experience with rechargeable IPGs was largely positive; however, frustrations with recharging and adverse events were common. Dystonia diagnosis was most predictive of high satisfaction across multiple categories, potentially related to expected long disease duration with need for numerous IPG replacements.
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Affiliation(s)
- Kyle T Mitchell
- Department of Neurology, University of California San Francisco, San Francisco, California, USA,
| | - Monica Volz
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Aaron Lee
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Marta San Luciano
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Sarah Wang
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Philip A Starr
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Paul Larson
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Nicholas B Galifianakis
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Jill L Ostrem
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
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Decreasing battery life in subthalamic deep brain stimulation for Parkinson's disease with repeated replacements: Just a matter of energy delivered? Brain Stimul 2019; 12:845-850. [DOI: 10.1016/j.brs.2019.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 11/17/2022] Open
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Akazawa M, Konomura K, Shiroiwa T. Cost-Minimization Analysis of Deep-Brain Stimulation Using National Database of Japanese Health Insurance Claims. Neuromodulation 2018; 21:548-552. [PMID: 29697171 DOI: 10.1111/ner.12782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/10/2018] [Accepted: 03/09/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES A new rechargeable dual-channel deep brain stimulation (DBS) system has been introduced for the treatment of Parkinson's disease and other movement disorders. However, the clinical value of the device, which has a high cost, remains unclear. MATERIALS AND METHODS We conducted a cost-minimization analysis using a national database of health insurance claims in Japan. DBS-related costs were compared between rechargeable and non-rechargeable devices and estimated across a 20-year period. RESULTS Although the price of rechargeable DBS was higher than that of non-rechargeable DBS, we observed total cost-savings of 8.4 million yen across 20 years by considering costs related to implantation surgery, frequency of replacement, and risk of complications. CONCLUSIONS In this study, real-world evidence indicated that rechargeable dual-channel DBS is a reasonable choice for saving total medical costs. Price revisions should consider cost-effectiveness findings for medical devices.
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Affiliation(s)
- Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan
| | - Keiko Konomura
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan.,Department of Health and Welfare Service, National Institution of Public Health, Wako, Saitama, Japan
| | - Takeru Shiroiwa
- Department of Health and Welfare Service, National Institution of Public Health, Wako, Saitama, Japan
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Lee HM, Howell B, Grill WM, Ghovanloo M. Stimulation Efficiency With Decaying Exponential Waveforms in a Wirelessly Powered Switched-Capacitor Discharge Stimulation System. IEEE Trans Biomed Eng 2017; 65:1095-1106. [PMID: 28829301 DOI: 10.1109/tbme.2017.2741107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The purpose of this study was to test the feasibility of using a switched-capacitor discharge stimulation (SCDS) system for electrical stimulation, and, subsequently, determine the overall energy saved compared to a conventional stimulator. We have constructed a computational model by pairing an image-based volume conductor model of the cat head with cable models of corticospinal tract (CST) axons and quantified the theoretical stimulation efficiency of rectangular and decaying exponential waveforms, produced by conventional and SCDS systems, respectively. Subsequently, the model predictions were tested in vivo by activating axons in the posterior internal capsule and recording evoked electromyography (EMG) in the contralateral upper arm muscles. Compared to rectangular waveforms, decaying exponential waveforms with time constants >500 μs were predicted to require 2%-4% less stimulus energy to activate directly models of CST axons and 0.4%-2% less stimulus energy to evoke EMG activity in vivo. Using the calculated wireless input energy of the stimulation system and the measured stimulus energies required to evoke EMG activity, we predict that an SCDS implantable pulse generator (IPG) will require 40% less input energy than a conventional IPG to activate target neural elements. A wireless SCDS IPG that is more energy efficient than a conventional IPG will reduce the size of an implant, require that less wireless energy be transmitted through the skin, and extend the lifetime of the battery in the external power transmitter.
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10
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De Vloo P, Raymaekers S, van Kuyck K, Luyten L, Gabriëls L, Nuttin B. Rechargeable Stimulators in Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Prospective Interventional Cohort Study. Neuromodulation 2017; 21:203-210. [PMID: 28256778 DOI: 10.1111/ner.12577] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND From 1999 onwards, deep brain stimulation (DBS) has been proposed as an alternative to capsulotomy in refractory cases of obsessive-compulsive disorder (OCD). Although rechargeable implantable pulse generators (rIPGs) have been used extensively in DBS for movement disorders, there are no reports on rIPGs in patients with a psychiatric DBS indication, and even possible objections to their use. OBJECTIVE We aim to evaluate rIPGs in OCD in terms of effectiveness, applicability, safety, and need for IPG replacement. METHODS In this prospective before-after study recruiting from 2007 until 2012, OCD patients requiring at least one IPG replacement per 18 months were proposed to have a rIPG implanted at the next IPG depletion. OCD severity was the primary outcome. Ten patients were analyzed. RESULTS Psychiatric symptoms and global functioning remained stable in the two years after as compared to the two years before rIPG implantation. Over the same period, the prescribed OCD medication doses did not increase and the DBS stimulation parameters were largely unaltered. Until the end of the follow-up (mean 4¾ years; maximum seven years), the DBS-related surgery frequency decreased and there were no rIPG replacements. During the first few weeks after implantation, two patients obsessively checked the rIPG, but afterwards there were no signs of compulsively checking or recharging the rIPG. Two patients experienced rIPG overdischarges (five occurrences in total). CONCLUSIONS This is the first report on rIPGs in DBS for OCD patients. The use of rIPGs in this population appears to be effective, applicable, and safe and diminishes the need for IPG replacements.
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Affiliation(s)
- Philippe De Vloo
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.,Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, Leuven, Belgium
| | - Simon Raymaekers
- Department of Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Kris van Kuyck
- Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, Leuven, Belgium
| | - Laura Luyten
- Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, Leuven, Belgium.,Research Group Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
| | | | - Bart Nuttin
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.,Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, Leuven, Belgium
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Cohn JA, Kowalik CG, Kaufman MR, Reynolds WS, Milam DF, Dmochowski RR. Evaluation of the axonics modulation technologies sacral neuromodulation system for the treatment of urinary and fecal dysfunction. Expert Rev Med Devices 2016; 14:3-14. [PMID: 27915486 DOI: 10.1080/17434440.2017.1268913] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Sacral neuromodulation (SNM) remains one of the few effective treatments for refractory bladder and bowel dysfunction. However, SNM is associated with frequent need for surgical intervention, in many cases because of a failed battery. A rechargeable SNM system, with a manufacturer-reported battery life of 15 years or more, has entered post-market clinical testing in Europe but has not yet been approved for clinical testing in the United States. Areas covered: We review existing neuromodulation technologies for the treatment of lower urinary tract and bowel dysfunction and explore the limitations of available technology. In addition, we discuss implantation technique and device specifications and programming of the rechargeable SNM system in detail. Lastly, we present existing evidence for the use of SNM in bladder and bowel dysfunction and evaluate the anticipated trajectory of neuromodulation technologies over the next five years. Expert commentary: A rechargeable system for SNM is a welcome technological advance. However surgical revision not related to battery changes is not uncommon. Therefore, while a rechargeable system would be expected to reduce costs, it will not eliminate the ongoing maintenance associated with neuromodulation. No matter the apparent benefits, all new technologies require extensive post-market monitoring to ensure safety and efficacy.
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Affiliation(s)
- Joshua A Cohn
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Casey G Kowalik
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Melissa R Kaufman
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - W Stuart Reynolds
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Douglas F Milam
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Roger R Dmochowski
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
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12
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Noblett KL, Dmochowski RR, Vasavada SP, Garner AM, Liu S, Pietzsch JB. Cost profiles and budget impact of rechargeable versus non-rechargeable sacral neuromodulation devices in the treatment of overactive bladder syndrome. Neurourol Urodyn 2016; 36:727-733. [DOI: 10.1002/nau.23008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/04/2016] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | | | - Shan Liu
- Wing Tech, Inc.; Menlo Park California
- University of Washington; Seattle Washington
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13
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Jia F, Hao H, Meng F, Guo Y, Zhang S, Zhang J, Li L. Patient perspectives on the efficacy of a new kind of rechargeable deep brain stimulators(1). Int J Neurosci 2015; 126:996-1001. [PMID: 27435521 DOI: 10.3109/00207454.2015.1092145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE/AIM OF THE STUDY Rechargeable deep brain stimulation (DBS) system with longer battery life has become available for treating movement disorders. However, little information exists about the safety and management after implantation. Therefore, there is an urgent need to evaluate the recharging performance through long-term observations. MATERIALS AND METHODS Fifty-three Parkinson's disease (PD) patients were implanted with a new rechargeable device (G102R, PINS Medical). They were observed at the baseline and 3 months, 6 months and 12 months after surgery, with measurement of the acceptance, frequency, recharging time and feeling during recharging. RESULTS The patients with the ages between 34 and 70 (57.64 ± 7.34) years thought the system was very easy to recharge. The favorite time interval for recharging was 1 week, and 10 days and half a month also chosen. Most of the patients spent around 1 hour recharging, with no unacceptable hot feelings reported. CONCLUSIONS The PD patients could easily and safely recharge this new rechargeable implantable neurostimulators. Thus, these neurostimulators might be an excellent choice for PD patients.
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Affiliation(s)
- Fumin Jia
- a National Engineering Laboratory for Neuromodulation , Tsinghua University , Beijing , China
| | - Hongwei Hao
- a National Engineering Laboratory for Neuromodulation , Tsinghua University , Beijing , China
| | - Fangang Meng
- b Department of Functional Neurosurgery , Beijing Neurosurgical Institute , Beijing , China
| | - Yi Guo
- c Department of Neurosurgery , Peking Union Medical College Hospital , Beijing , China
| | - Shizhong Zhang
- d Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Jianguo Zhang
- b Department of Functional Neurosurgery , Beijing Neurosurgical Institute , Beijing , China
| | - Luming Li
- a National Engineering Laboratory for Neuromodulation , Tsinghua University , Beijing , China
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Howell B, Huynh B, Grill WM. Design and in vivo evaluation of more efficient and selective deep brain stimulation electrodes. J Neural Eng 2015; 12:046030. [PMID: 26170244 DOI: 10.1088/1741-2560/12/4/046030] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an effective treatment for movement disorders and a promising therapy for treating epilepsy and psychiatric disorders. Despite its clinical success, the efficiency and selectivity of DBS can be improved. Our objective was to design electrode geometries that increased the efficiency and selectivity of DBS. APPROACH We coupled computational models of electrodes in brain tissue with cable models of axons of passage (AOPs), terminating axons (TAs), and local neurons (LNs); we used engineering optimization to design electrodes for stimulating these neural elements; and the model predictions were tested in vivo. MAIN RESULTS Compared with the standard electrode used in the Medtronic Model 3387 and 3389 arrays, model-optimized electrodes consumed 45-84% less power. Similar gains in selectivity were evident with the optimized electrodes: 50% of parallel AOPs could be activated while reducing activation of perpendicular AOPs from 44 to 48% with the standard electrode to 0-14% with bipolar designs; 50% of perpendicular AOPs could be activated while reducing activation of parallel AOPs from 53 to 55% with the standard electrode to 1-5% with an array of cathodes; and, 50% of TAs could be activated while reducing activation of AOPs from 43 to 100% with the standard electrode to 2-15% with a distal anode. In vivo, both the geometry and polarity of the electrode had a profound impact on the efficiency and selectivity of stimulation. SIGNIFICANCE Model-based design is a powerful tool that can be used to improve the efficiency and selectivity of DBS electrodes.
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Affiliation(s)
- Bryan Howell
- Duke University, Department of Biomedical Engineering, Durham, NC, USA
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Johansson V, Garwicz M, Kanje M, Halldenius L, Schouenborg J. Thinking Ahead on Deep Brain Stimulation: An Analysis of the Ethical Implications of a Developing Technology. AJOB Neurosci 2014; 5:24-33. [PMID: 24587963 PMCID: PMC3933012 DOI: 10.1080/21507740.2013.863243] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Deep brain stimulation (DBS) is a developing technology. New generations of DBS technology are already in the pipeline, yet this particular fact has been largely ignored among ethicists interested in DBS. Focusing only on ethical concerns raised by the current DBS technology is, albeit necessary, not sufficient. Since current bioethical concerns raised by a specific technology could be quite different from the concerns it will raise a couple of years ahead, an ethical analysis should be sensitive to such alterations, or it could end up with results that soon become dated. The goal of this analysis is to address these changing bioethical concerns, to think ahead on upcoming and future DBS concerns both in terms of a changing technology and changing moral attitudes. By employing the distinction between inherent and noninherent bioethical concerns we identify and make explicit the particular limits and potentials for change within each category, respectively, including how present and upcoming bioethical concerns regarding DBS emerge and become obsolete. Many of the currently identified ethical problems with DBS, such as stimulation-induced mania, are a result of suboptimal technology. These challenges could be addressed by technical advances, while for instance perceptions of an altered body image caused by the mere awareness of having an implant may not. Other concerns will not emerge until the technology has become sophisticated enough for new uses to be realized, such as concerns on DBS for enhancement purposes. As a part of the present analysis, concerns regarding authenticity are used as an example.
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Waln O, Jimenez-Shahed J. Rechargeable Deep Brain Stimulation Implantable Pulse Generators in Movement Disorders: Patient Satisfaction and Conversion Parameters. Neuromodulation 2013; 17:425-30; discussion 430. [DOI: 10.1111/ner.12115] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/09/2013] [Accepted: 08/06/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Olga Waln
- Department of Neurology; Baylor College of Medicine; Houston TX USA
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