Deep Brain Stimulation Battery Longevity: Comparison of Monopolar Versus Bipolar Stimulation Modes

Deep brain stimulation is an effective treatment for movement disorders, but it is relatively complex, invasive, and costly. Little is known about whether stimulation mode alters pulse generator (battery) longevity in routine clinical care.

To compare battery longevity during monopolar versus bipolar stimulation in patients who underwent deep brain stimulation for movement disorders.

We evaluated 2,902 programming adjustments and calculated the average stimulator settings for 393 batteries in 200 unique patients with Parkinson's disease and essential tremor. We classified the pulse generators into different stimulation modes (monopolar, bipolar, tripolar, double monopolar) and compared battery longevity with Kaplan Meier survival analyses using the log rank test. We exclusively implanted the Medtronic 3387 lead with adjacent electrode contacts separated by 1.5 mm.

The mean pulse generator longevity was 47.6±1.6 months regardless of diagnosis or stimulation mode. Bipolar stimulation mode was associated with greater longevity than monopolar stimulation (56.1±3.4 versus 44.2±2.1 months, p=0.006). This effect was most pronounced when stimulation parameters were at low to moderate intensity settings. Double monopolar configuration was associated with less pulse generator longevity than conventional stimulation modes (37.8±5.6 versus 49.7±1.9, p=0.014).

IPGs initially programmed in bipolar mode provided one year of additional battery longevity versus monopolar mode in this large retrospective series of patients with essential tremor and Parkinson's disease. Given satisfactory efficacy for motor symptoms, bipolar stimulation mode is a feasible alternative programming strategy at the initiation of DBS therapy.