Is a patient controller for Parkinson's disease patients with subthalamic nucleus deep brain stimulation reasonable?

A patient controller (PC) is an optional device for patients with deep brain stimulation (DBS) to have limited control of their stimulator system.

We investigated the impact of a PC on DBS safety, most notably the handling/prevention of unexpected DBS failure in patients with Parkinson's disease (PD).

PD patients with subthalamic DBS were educated in the use of a PC. After a first impulse generator (IPG) replacement, data on the use of the PC were obtained from the patients' records and by a patient questionnaire.

A total of 27 patients with IPG replacements after 4.4 ± 0.8 years (118.8 patient-years) were included. Thirteen patients transiently used the PC to optimize stimulation amplitudes. Eighteen patients reported events when they used the PC to ensure DBS being on. No accidental switch off by environmental electromagnetism was confirmed. In contrast, 4 patients accidentally turned the IPG off with the PC. Sixteen patients regularly checked the IPG battery but only 1 patient noted a low battery status before quarterly control visits. Of the 27 patients, 26 had anticipated and only 1 an unanticipated IPG replacement.

A PC is not needed for patient safety. However, in some patients, a PC is helpful to optimize stimulation amplitudes and to increase the patients' own perception of safety.