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Replacement of neurostimulator


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#1 MIMILASTER

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Posted 30 January 2014 - 05:58 AM

Hello,

 

After 7 years of loyal service, my "old" Soletras were replaced yesterday by a newer type of stimulator, Activa 37602. I seem a little dyskinetic since these were installed, which could tend to imply that they are more efficient than the previous model.  I would like to know if you have had similar experiences with your patients and if my conclusion is correct.

I wish to thank you for the remarkable support you provide to the Parkinson community worldwide. Your outstanding contribution deserves our praise and grateful recognition.

Mimi



#2 Dr. Okun

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Posted 31 January 2014 - 07:32 AM

Mimi thank you.

 

We have seen this phenomenon before in our clinic, and I would recommend that you see your doc as many times the stimulators need to be slightly turned down.  No two batteries are equal and certainly changing from one battery type to another can result in these issues.  Also, sometimes the battery at the end of life is turned up by the programmer in clinic, and in those cases the battery often needs to be turned back down.


Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#3 am0665

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Posted 14 February 2014 - 02:28 PM

Bonjour Mimi,

 

My family member's bilateral Soletras lasted approximately four years; similar voltage to yours, but in bi-polar and multi-polar contact selections.

After change to bilateral Activa SCs, he was able to settle down after a while to similar settings.

Beyond Dr. Okun's comment on intra-battery variability, and end-of-life voltage for the Soletra:

- it is my understanding that the SC has a somewhat different pulse shape form

- I assume that you're comparing both models with all settings the same: constant voltage mode

- could your therapeutic window be smaller than a 10% variability in field strength?

Two additional reactions I'd like to request of Dr. Okun:

- it has been our experience, that -- all other parameters having changed little -- the battery life of the Activa SC was only half that of the Soletra

- Activa SC battery duration indication: given your promoting online formulas for residual battery life, would you be able to predict time left for this model, given current IPG voltage indication and bi-polar / multi-polar settings?

 

Thank you.



#4 Dr. Okun

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Posted 15 February 2014 - 07:48 AM

We have not personally seen the battery life between soletra and SC to be very different; but there are technical differences.  You can actually plug in the parameters from both DBS batteries into the estimators and get the battery life.  Also consider that it is possible over the course of the battery life that many settings are tried and this can impact DBS battery/neurostimulator life.  Here is the link to the Deep Brain Stimulation (DBS) battery life estimator app in case it is helpful to you.  Also here is the google/droid version of the Deep Brain Stimulation battery life estimator.

 

Here are a couple of articles on the topic:

 

 

Neuromodulation. 2013 Mar-Apr;16(2):147-53. doi: 10.1111/j.1525-1403.2012.00457.x. Epub 2012 May 30.
An algorithm for management of deep brain stimulation battery replacements: devising a web-based battery estimator and clinical symptom approach.
Abstract
OBJECTIVE:

Deep brain stimulation (DBS) is an effective technique that has been utilized to treat advanced and medication-refractory movement and psychiatric disorders. In order to avoid implanted pulse generator (IPG) failure and consequent adverse symptoms, a better understanding of IPG battery longevity and management is necessary.

BACKGROUND:

Existing methods for battery estimation lack the specificity required for clinical incorporation. Technical challenges prevent higher accuracy longevity estimations, and a better approach to managing end of DBS battery life is needed.

METHODS:

The literature was reviewed and DBS battery estimators were constructed by the authors and made available on the web at http://mdc.mbi.ufl.e...ttery-estimator. A clinical algorithm for management of DBS battery life was constructed. The algorithm takes into account battery estimations and clinical symptoms.

RESULTS:

Existing methods of DBS battery life estimation utilize an interpolation of averaged current drains to calculate how long a battery will last. Unfortunately, this technique can only provide general approximations. There are inherent errors in this technique, and these errors compound with each iteration of the battery estimation. Some of these errors cannot be accounted for in the estimation process, and some of the errors stem from device variation, battery voltage dependence, battery usage, battery chemistry, impedance fluctuations, interpolation error, usage patterns, and self-discharge. We present web-based battery estimators along with an algorithm for clinical management. We discuss the perils of using a battery estimator without taking into account the clinical picture.

CONCLUSION:

Future work will be needed to provide more reliable management of implanted device batteries; however, implementation of a clinical algorithm that accounts for both estimated battery life and for patient symptoms should improve the care of DBS patients.

© 2012 International Neuromodulation Society.

PMID:   22646907   [PubMed - indexed for MEDLINE]

 

 

PLoS One. 2013;8(3):e58665. doi: 10.1371/journal.pone.0058665. Epub 2013 Mar 11.
Management of deep brain stimulator battery failure: battery estimators, charge density, and importance of clinical symptoms.
Abstract
OBJECTIVE:

We aimed in this investigation to study deep brain stimulation (DBS) battery drain with special attention directed toward patient symptoms prior to and following battery replacement.

BACKGROUND:

Previously our group developed web-based calculators and smart phone applications to estimate DBS battery life (http://mdc.mbi.ufl.e...ttery-estimator).

METHODS:

A cohort of 320 patients undergoing DBS battery replacement from 2002-2012 were included in an IRB approved study. Statistical analysis was performed using SPSS 20.0 (IBM, Armonk, NY).

RESULTS:

The mean charge density for treatment of Parkinson's disease was 7.2 µC/cm(2)/phase (SD = 3.82), for dystonia was 17.5 µC/cm(2)/phase (SD = 8.53), for essential tremor was 8.3 µC/cm(2)/phase (SD = 4.85), and for OCD was 18.0 µC/cm(2)/phase (SD = 4.35). There was a significant relationship between charge density and battery life (r = -.59, p<.001), as well as total power and battery life (r = -.64, p<.001). The UF estimator (r = .67, p<.001) and the Medtronic helpline (r = .74, p<.001) predictions of battery life were significantly positively associated with actual battery life. Battery status indicators on Soletra and Kinetra were poor predictors of battery life. In 38 cases, the symptoms improved following a battery change, suggesting that the neurostimulator was likely responsible for symptom worsening. For these cases, both the UF estimator and the Medtronic helpline were significantly correlated with battery life (r = .65 and r = .70, respectively, both p<.001).

CONCLUSIONS:

Battery estimations, charge density, total power and clinical symptoms were important factors. The observation of clinical worsening that was rescued following neurostimulator replacement reinforces the notion that changes in clinical symptoms can be associated with battery drain.

PMID:   23536810   [PubMed - indexed for MEDLINE]    PMCID:   PMC3594176     Free PMC Article

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#5 MIMILASTER

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Posted 19 February 2014 - 08:31 PM

Bonjour Mimi,

 

My family member's bilateral Soletras lasted approximately four years; similar voltage to yours, but in bi-polar and multi-polar contact selections.

After change to bilateral Activa SCs, he was able to settle down after a while to similar settings.

Beyond Dr. Okun's comment on intra-battery variability, and end-of-life voltage for the Soletra:

- it is my understanding that the SC has a somewhat different pulse shape form

- I assume that you're comparing both models with all settings the same: constant voltage mode

- could your therapeutic window be smaller than a 10% variability in field strength?

Two additional reactions I'd like to request of Dr. Okun:

- it has been our experience, that -- all other parameters having changed little -- the battery life of the Activa SC was only half that of the Soletra

- Activa SC battery duration indication: given your promoting online formulas for residual battery life, would you be able to predict time left for this model, given current IPG voltage indication and bi-polar / multi-polar settings?

 

Thank you.

Dear am0665   (Bonjour Andy!)

 

My old Soletra lasted from November 2006 till January 2014. And we anticipated the need a bit (because i'm planning an overseas trip and did not want to take the risk of batteries depleting while thousands miles away). It could have certainly lasted 6 more months. Now i've had the same parameters since August 2009 : one side monopolar case +, the other side bi-polar case off.  I'm not sure I fully grasp what you mean by 10% variability of field strength (I never exhibited much talent in physics). What I can say is th



#6 MIMILASTER

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Posted 19 February 2014 - 08:34 PM

Bonjour Mimi,

 

My family member's bilateral Soletras lasted approximately four years; similar voltage to yours, but in bi-polar and multi-polar contact selections.

After change to bilateral Activa SCs, he was able to settle down after a while to similar settings.

Beyond Dr. Okun's comment on intra-battery variability, and end-of-life voltage for the Soletra:

- it is my understanding that the SC has a somewhat different pulse shape form

- I assume that you're comparing both models with all settings the same: constant voltage mode

- could your therapeutic window be smaller than a 10% variability in field strength?

Two additional reactions I'd like to request of Dr. Okun:

- it has been our experience, that -- all other parameters having changed little -- the battery life of the Activa SC was only half that of the Soletra

- Activa SC battery duration indication: given your promoting online formulas for residual battery life, would you be able to predict time left for this model, given current IPG voltage indication and bi-polar / multi-polar settings?

 

Thank you.

sorry, I did not finish my post. please wait for complete text ! I pressed the wrong key !



#7 MIMILASTER

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Posted 19 February 2014 - 09:55 PM

Bonjour Mimi,

 

My family member's bilateral Soletras lasted approximately four years; similar voltage to yours, but in bi-polar and multi-polar contact selections.

After change to bilateral Activa SCs, he was able to settle down after a while to similar settings.

Beyond Dr. Okun's comment on intra-battery variability, and end-of-life voltage for the Soletra:

- it is my understanding that the SC has a somewhat different pulse shape form

- I assume that you're comparing both models with all settings the same: constant voltage mode

- could your therapeutic window be smaller than a 10% variability in field strength?

Two additional reactions I'd like to request of Dr. Okun:

- it has been our experience, that -- all other parameters having changed little -- the battery life of the Activa SC was only half that of the Soletra

- Activa SC battery duration indication: given your promoting online formulas for residual battery life, would you be able to predict time left for this model, given current IPG voltage indication and bi-polar / multi-polar settings?

 

Thank you.

Hello am0665 (Bonjour Andy !), hello Dr OKUN,

 

My old Soletras lasted from November 2006 till January 2014.  They could have lasted even longer , at least 6 months, but we anticipated the need as I am planning an overseas trip and did not want to be caught unguarded.  Now I have the same parameters since August 2009, i. e., one side monopolar, with case +, and the other side bipolar with case off. I’m not sure I fully grasp what you mean by 10% variability in field strength (never had a passion for physics!), All I can say is the Fq is always the same  (130 HZ), DI is always 60, and  AMP is 2V on the bipolar side and 2.5V on the other and  when we tried to move that one up a bit, it was counterproductive.  

While these almost 4 and a half years went without any change, the first three were very chaotic, with frequent changes of the parameters (with a different neurologist). 

To update my initial impression on my new equipment,  I have experienced  a similar feeling after replacement of my neurostimulators  as I had for the initial DBS surgery; a feeling that my body is freed of a lot of weight, not completely cured but a lot better; this feeling is sometimes referred as the “lesioning effect”after DBS surgery, which obviously cannot apply in this case.  I don’t know if any patient of Dr Okun has ever reported the same experience.  Unfortunately, this wonderful feeling only lasted a few days.  The reason why I can be so precise about my parameters is that my neurologist always fill up my Patient Follow up Book  (provided by Medtronic) each time he checks my stimulators.  I can only encourage patients who do not have this information to press their neurologist or programmer to take the time to fill up these data; it is so important for patients to have knowledge of what is being tried, even if you do entirely master the subjects.

Now, exactly three weeks after replacement surgery, I feel exactly the same with my new equipment as with my previous Soletras. For your information, the previous IPG was an ITREL II and lasted from March 15, 2000 (won't forget the day !) till November 2006.

Hope this information is of some help.

 

Mimi (aka Mireille)



#8 Dr. Okun

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Posted 22 February 2014 - 09:21 AM

Thanks for the post.  Different battery types when replaced may have different power and therefore need to be adjusted up or down by 10-20% (usually the voltage/amplitude) to obtain a similar effect as the previous battery.  Anaesthesia can also in some cases improve PD symptoms and it could have been the anesthetic.  Finally, you may want to try a slightly higher voltage and see if you can recapture the 3 weeks of benefit.  These are a few suggestions for your doctor.


Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#9 janvier

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Posted 26 February 2014 - 10:27 AM

Bonjour to All,

Dear Doctor, I have been reading your input on battery life estimation. As far as I can see we are talking about Medtronics batteries. How can we do similar computations for St Jude Batteries such as LibraXP. Is it possible to give some useful links in this area? Thanks a lot. 



#10 Dr. Okun

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Posted 26 February 2014 - 11:30 AM

I have not seen anything published on St. Jude batteries so the best you can do is call their engineering team.


Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips





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