Objective: Here, we aimed to evaluate the management of stimulation intensities after switching from NRC to RC IPG compared to previous RC-to-RC replacements.

Background: Patients with pallidal deep brain stimulation (DBS) for dystonia often need continuous increase of their stimulation intensities to maintain a stable therapeutic effect. Non-rechargeable implantable pulse generators (IPG) have traditionally been used and after such IPG replacements, a decrease of stimulation intensities of about 20% frequently could be achieved.

Methods: Patients with dystonia and pallidal DBS, who were switched from a NRC to RC IPG technology were identified. Modifications of stimulation intensities with otherwise stable settings during NRC battery life and during the observation period of RC use were analysed. Changes in stimulation intensities before/after switch from NRC to RC IPGs were calculated and compared with modifications of settings before/after NRC-to-NRC IPG replacements. Statistical analysis was performed using the Wilcoxon rank test for paired variables and Mann-Whitney-U-test.

Results: Eleven patients (7 men; mean age at DBS 50.3+/-11.7 years; mean DBS duration 120+/-33 months) were included. Mean battery life of NRCs was 20.6+/-6.5 months. RC observation period was 69.5+/-19.1 months. In the NRC-to-NRC setting, mean increase during battery life was 1.14V (p<0.05). Stimulation intensity was reduced by 19.4% (p<0.005) when restarting with a new IPG. In the NRC-to-RC constellation, during the RC observation period stimulation intensities were increased in 7 patients and reduced in 4 (overall mean decrease 0.1V; p=0.48). Management of stimulation intensity when switching from NRC to RC was heterogeneous: in 7 patients a mean reduction by 19.5% was performed, in 2 there was no change, and 2 had mild mean increase of 1.3%. Overall mean reduction was 12.2% (p<0.05), which was significantly less than in the NRC-to-NRC situation (p<0.05).

Conclusions: Switching from NRC to RC IPGs in pallidal DBS for dystonia needs more variability and individualized adaptation than in classical NRC-to-NRC replacements. Indeed, after the replacement stimulation intensities were not reduced as much as previously. Over one third of the patients reduced stimulation intensities over time. These heterogeneous results might reflect neuroplasticity effects but also technical aspects of RC DBS systems.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/from-non-rechargeable-to-rechargeable-technology-insights-and-management-of-pallidal-deep-brain-stimulation-in-dystonia-after-switching-to-a-rechargeable-implantable-pulse-generator/