Frontiers in Human Neuroscience (Aug 2021)
Implantable Pulse Generators for Deep Brain Stimulation: Challenges, Complications, and Strategies for Practicality and Longevity
- Can Sarica,
- Christian Iorio-Morin,
- Christian Iorio-Morin,
- David H. Aguirre-Padilla,
- David H. Aguirre-Padilla,
- Ahmed Najjar,
- Ahmed Najjar,
- Michelle Paff,
- Michelle Paff,
- Anton Fomenko,
- Kazuaki Yamamoto,
- Ajmal Zemmar,
- Ajmal Zemmar,
- Ajmal Zemmar,
- Nir Lipsman,
- George M. Ibrahim,
- Clement Hamani,
- Clement Hamani,
- Mojgan Hodaie,
- Mojgan Hodaie,
- Mojgan Hodaie,
- Andres M. Lozano,
- Andres M. Lozano,
- Andres M. Lozano,
- Renato P. Munhoz,
- Renato P. Munhoz,
- Alfonso Fasano,
- Alfonso Fasano,
- Alfonso Fasano,
- Suneil K. Kalia,
- Suneil K. Kalia,
- Suneil K. Kalia,
- Suneil K. Kalia
Affiliations
- Can Sarica
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Christian Iorio-Morin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Christian Iorio-Morin
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
- David H. Aguirre-Padilla
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- David H. Aguirre-Padilla
- Department of Neurology & Neurosurgery, Center Campus, Universidad de Chile, Santiago, Chile
- Ahmed Najjar
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Ahmed Najjar
- Department of Surgery, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
- Michelle Paff
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Michelle Paff
- Department of Neurosurgery, University of California, Irvine, Irvine, CA, United States
- Anton Fomenko
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Kazuaki Yamamoto
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Ajmal Zemmar
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Ajmal Zemmar
- Department of Neurosurgery, Henan University School of Medicine, Zhengzhou, China
- Ajmal Zemmar
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, KY, United States
- Nir Lipsman
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- George M. Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Clement Hamani
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Mojgan Hodaie
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Mojgan Hodaie
- 0CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, ON, Canada
- Andres M. Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Andres M. Lozano
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Andres M. Lozano
- 0CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, ON, Canada
- Renato P. Munhoz
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Renato P. Munhoz
- 1Edmond J. Safra Program in Parkinson’s Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, and Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
- Alfonso Fasano
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Alfonso Fasano
- 0CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, ON, Canada
- Alfonso Fasano
- 1Edmond J. Safra Program in Parkinson’s Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, and Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
- Suneil K. Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Suneil K. Kalia
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Suneil K. Kalia
- 0CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, ON, Canada
- Suneil K. Kalia
- 2KITE, University Health Network, Toronto, ON, Canada
- DOI
- https://doi.org/10.3389/fnhum.2021.708481
- Journal volume & issue
-
Vol. 15
Abstract
Deep brain stimulation (DBS) represents an important treatment modality for movement disorders and other circuitopathies. Despite their miniaturization and increasing sophistication, DBS systems share a common set of components of which the implantable pulse generator (IPG) is the core power supply and programmable element. Here we provide an overview of key hardware and software specifications of commercially available IPG systems such as rechargeability, MRI compatibility, electrode configuration, pulse delivery, IPG case architecture, and local field potential sensing. We present evidence-based approaches to mitigate hardware complications, of which infection represents the most important factor. Strategies correlating positively with decreased complications include antibiotic impregnation and co-administration and other surgical considerations during IPG implantation such as the use of tack-up sutures and smaller profile devices.Strategies aimed at maximizing battery longevity include patient-related elements such as reliability of IPG recharging or consistency of nightly device shutoff, and device-specific such as parameter delivery, choice of lead configuration, implantation location, and careful selection of electrode materials to minimize impedance mismatch. Finally, experimental DBS systems such as ultrasound, magnetoelectric nanoparticles, and near-infrared that use extracorporeal powered neuromodulation strategies are described as potential future directions for minimally invasive treatment.
Keywords
- battery life
- neuromodulation
- complications
- DBS (deep brain stimulation)
- IPG (implantable pulse generator)
- longevity
