Pulse Width and Implantable Pulse Generator Longevity in Pallidal Deep Brain Stimulation for Dystonia: A...

Area of Science:

• Neurology
• Neurosurgery
• Biomedical Engineering

Background:

• Globus pallidus internus (GPi) deep brain stimulation (DBS) utilizes various pulse widths (PWs) for dystonia management.
• No definitive PW has shown clinical superiority, leading to varied programming paradigms across centers.

Purpose of the Study:

• To evaluate the impact of different PW paradigms in GPi DBS for dystonia on implantable pulse generator (IPG) longevity and energy consumption.
• To compare short (60-90 µs) versus long (450 µs) PWs in GPi DBS for dystonia.

Main Methods:

• Retrospective analysis of 39 dystonia patients undergoing bilateral GPi DBS at two Swedish centers (2005-2015).
• Comparison of IPG replacement frequency, pulse effective voltage (PEV), IPG models, and clinical outcomes (CGI scale) between short and long PW groups.
• Analysis included pre-/postoperative imaging and electrode placement relative to the GPi sensorimotor region.

Main Results:

• Average IPG longevity was significantly longer with short PWs (1,129 ± 50 days) compared to long PWs (925 ± 32 days; p = 0.0005).
• IPG longevity inversely correlated with PEV (r = -0.667, p < 0.0001).
• No significant differences in longevity were observed between IPG models (Kinetra® vs. Activa® PC) or based on electrode location.

Conclusions:

• Short PWs in GPi DBS for dystonia are associated with decreased energy consumption and extended IPG longevity.
• These benefits are independent of IPG model or electrode positioning.
• Short PWs may be a more energy-efficient choice for initial programming in GPi DBS for dystonia, without compromising clinical outcomes.