Rechargeable deep brain stimulation implantable pulse generator [Neurosurgery Wiki]

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====== Rechargeable deep brain stimulation implantable pulse generator ======
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The [[Activa]] PC [[implantable pulse generator]] (IPG) demonstrates a significantly reduced [[battery]] life of 2.1 years, with a median battery life of 4.5 years in comparison to 6.6 years in the [[Kinetra]] IPG. Future [[technology]] developments should therefore be focused on improving the battery life of the newer IPG systems
((Fisher B, Kausar J, Garratt H, Hodson J, White A, Ughratdar I, Mitchell R.
Battery Longevity Comparison of Two Commonly Available Dual Channel Implantable
Pulse Generators Used for Subthalamic Nucleus Stimulation in Parkinson's Disease.
Stereotact Funct Neurosurg. 2018;96(3):151-156. doi: 10.1159/000488684. Epub 2018
Jun 19. PubMed PMID: 29920479.
)).

Nonrechargeable [[deep brain stimulation]] [[implantable pulse generator]]s (IPGs) for [[movement disorder]]s require surgical replacement every few years due to [[battery]] depletion. Rechargeable IPGs reduce frequency of replacement surgeries and inherent risks of [[complication]]s but require frequent recharging
((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 Jul 9:1-7. doi: 10.1159/000500993. [Epub ahead of print] PubMed
PMID: 31288242.
)).

Rechargeable [[deep brain stimulation]] [[implantable pulse generator]] for [[movement disorder]]s are well received by patients as initial therapy and after conversion. Mild reduction in stimulation parameters might be allowed after conversion to RC IPG
((Waln O, Jimenez-Shahed J. Rechargeable deep brain stimulation implantable
pulse generators in movement disorders: patient satisfaction and conversion
parameters. Neuromodulation. 2014 Jul;17(5):425-30; discussion 430. doi:
10.1111/ner.12115. Epub 2013 Sep 24. PubMed PMID: 24112630.
)).

However, there is now a choice between fixed-life and rechargeable batteries, with each having their own advantages and disadvantages. 

Most patients in a adult cohort with movement disorders chose the fixed-life battery. The better lifestyle associated with a fixed-life battery is a major factor influencing their choice. Rechargeable batteries may be more acceptable if the recharging process is improved, more convenient, and discreet
((Khaleeq T, Hasegawa H, Samuel M, Ashkan K. Fixed-Life or Rechargeable Battery 
for Deep Brain Stimulation: Which Do Patients Prefer? Neuromodulation. 2019
Jun;22(4):489-492. doi: 10.1111/ner.12810. Epub 2018 Aug 22. PubMed PMID:
30133071.
)).
----
Mitchell et al., evaluated patient experience with rechargeable IPGs and define predictive characteristics for higher [[satisfaction]].

They contacted all patients implanted with rechargeable IPGs at a single [[center]] in a [[survey]]-based study. They analyzed patient satisfaction with respect to [[age]], [[diagnosis]], target, charging duration, and [[body mass index]]. They tabulated [[hardware]]-related adverse events.

[[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.

Patient experience with rechargeable IPGs was largely positive; however, frustrations with recharging and [[adverse event]]s 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
((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 Jul 9:1-7. doi: 10.1159/000500993. [Epub ahead of print] PubMed
PMID: 31288242.
)).
----
Hitti et al., implanted rechargeable stimulators in 206 patients undergoing DBS surgery, and demonstrated the cost-effectiveness and high patient satisfaction associated with this procedure
((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. 2018 Sep 1:1-8. doi:
10.3171/2018.4.JNS172995. [Epub ahead of print] PubMed PMID: 30265199.
)).

===== References =====