Two types of Neurostimulators are available- rechargeable and non-rechargeable. There is no difference in the improvement of symptoms obtained by the two stimulators.
The non-rechargeable neurostimulator has to be replaced when its battery runs out of charge; on an average, it may take around 3-4 years for this to happen. The battery may run out of charge early and will require replacement earlier, if a higher current than usual need to be used for stimulation in the patient because of certain disease related factors.
The re- chargeable stimulator has a life of 8-9 years (after which it needs to be replaced) as stated by the manufacturer; however, it needs to be charged once in 3-5 days, using an external re-charger.
The re-chargeable stimulator is more expensive. The warranty period and the clauses for the implanted hardware including the stimulator and its accessories (like the patient’s therapy controller unit (“remote control”), the re-charger etc) are specified by the manufacturer.
The manufacturer has to be contacted for any technical malfunctioning of the implanted DBS hardware/ accessories and the manufacturer shall handle such technical problems as per the clauses specified in the warranty document.
The patients planning to undergo DBS surgery and their caregivers are advised to understand clearly the manufacturer’s policies regarding warranty, before undergoing the surgery.
The manufacturer also provides a Patient Therapy Guide for the understanding of patients and caregivers, and it is also advisable to read and understand this before undergoing the procedure. Your doctors will help you if you have any difficulty in understanding any of the information provided in the brochures; feel free to contact them.
DBS is used for the treatment of other conditions like dystonia and various tremor disorders, including Essential Tremor. In these conditions, the brain target used is different from the one used in PD (subthalamic nucleus).
What are the other surgical procedures used to treat PD and other movement disorders?
The other surgical procedures include stereotactic thalamotomy and pallidotomy. In these procedures, a small surgical “lesion” is produced in the brain target, to alter its function and relieve the symptoms. The patient is selected for these lesioning surgeries, when symptoms cannot be controlled by medical management alone and DBS is not possible due to technical or other (eg: financial) reasons. These procedures are much less expensive than DBS; however the results are also inferior to those of DBS. Generally, these lesioning surgeries can be done only on one side, as doing the surgery on both sides of the brain can have complications like significant degree of speech disturbance.
Regular follow-up is needed after surgery, to detect promptly and correct if possible those symptoms which are not amenable to DBS. These include depression, urinary bladder disturbances, behavioral problems, memory and intellectual dysfunction etc. The patient also may require programming or adjustment of medications for movement-related symptoms worsening over time.
Patients with DBS system implanted should consult the movement disorder specialist before going for any other major investigation or treatment. If a medical test is prescribed, the testing physician must be told about the implanted system.
Diathermy: Forms of diathermy like short wave diathermy, microwave diathermy or therapeutic ultrasound diathermy anywhere on the body may be risky for patients with an implanted neurostimulator system and should be avoided. Energy from the diathermy can be transferred through the implanted system, causing tissue damage and can result in severe injury or even death. Diathermy can also damage parts of the neurostimulator system. Injury or damage can occur during diathermy treatment irrespective of whether the neurostimulator system is turned ON or OFF.
Diagnostic ultrasound, electrolysis, radiation therapy, and electrocautery also should not be used directly over the implant site. During dental / other surgical procedures, monopolar cautery should be avoided. Bipolar cautery, if unavoidable, can be used with caution, with the lowest current settings possible. The grounding pad should not be placed near the DBS device. If bipolar cautery has to be used during the procedure, the voltage of the DBS needs to be turned down to zero, and the Pulse Generator (neurostimulator) should be turned OFF before the procedure starts. Precautions should be taken while using dental instruments like dental drill and ultrasonic probes used to clean the teeth. The Deep Brain Stimulation patient Therapy Guide available with the patient should be referred prior to use of bipolar cautery / any other electrical equipment on the patient, and the manufacturer of DBS system should be contacted if the compatibility of any electrical equipment is doubtful. Dental infections following the procedure should be avoided and antibiotic prophylaxis may be used if needed.
The electrical discharge from defibrillators may damage the neurostimulator and also cause tissue damage.
The patient is provided with an identification card when they leave the hospital after surgery. This card provides basic information about the pulse generator and contact details of the treating doctor. This has to be carried while travelling. Certificate mentioning the precautions will also be given. The identification card and the certificate can be shown to security personal and is likely to help the patient bypass theft detectors, security gates, metal detectors etc (for example, in airports) which may cause parameter changes in the neurostimulator system.
In the unfortunate event of the death of a patient with DBS, the neurostimulator must be removed prior to cremation, as the device may explode if put in fire. This can be done in a near by hospital by a general surgeon.
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