Battery obsolescence, industry profit and deep brain stimulation

Excerpt

Deep brain stimulation (DBS) is an evidence-based efficient surgical therapy for advanced Parkinson’s disease, dystonia and tremor. It has virtually replaced ablative lesions (thalamotomy, pallidotomy), especially thanks to its safety when applied bilaterally on the motor thalamus, the globus pallidus and the subthalamic nucleus. Also, the “reversibility” of DBS has been a long-advertised feature of this therapy. However, it is evident today that after some time, DBS is no longer “reversible”, meaning that patients cannot just stop the stimulation and go back to usual medications. In fact, a sudden arrest of chronic DBS may be dangerous for patients, provoking a rebound of symptoms that may even lead to death, due to medication-refractory malignant Parkinsonian crisis, or dystonic crisis [3, 4, 14, 15]. This has led to a new “diagnosis” being proposed: “DBS withdrawal syndrome” [9, 13, 14]. Patients may become “hooked” on DBS and will need regular battery replacements, with financial and clinical consequences such as increased risk for infection at each implantable pulse generator (IPG) replacement [5, 12]. IPGs with rechargeable batteries are not suitable to many DBS patients due to their reluctance, or to advanced age or difficulty to manage the regular charging of the batteries, or even due to costs. …