Deep Brain Stimulation Battery Longevity: Impact of Anesthesia Modality and Anatomic Target

Introduction: Deep brain stimulation (DBS) effectively treats various movement disorders, though DBS batteries require routine replacement. Factors affecting battery longevity remain unclear, with studies indicating variations based on battery settings (e.g., bipolar vs. monopolar stimulation) and device model. Recent advancements in intra-operative guidance enable DBS placement under general anesthesia instead of conscious sedation (MAC). This study examines the impact of anesthesia type at time of installation on DBS battery longevity and explores other influencing factors, such as stimulation target.

Methods: Retrospective chart review of 251 patients who underwent DBS placement between 2013 and 2021 at a tertiary care center was completed under an IRB approved protocol. Using an accelerated failure times (AFT) model, battery longevity was assessed as a function of anesthesia type, anatomic target of electrodes, DBS settings, patient diagnosis, demographic factors, UPDRS score, and battery model.

Results: DBS battery was significantly more likely to require replacement if installed under MAC HR=2.596 (p < 0.05) compared to general anesthesia. Battery replacement was significantly less likely if electrodes were implanted in the subthalamic nucleus, HR=0.208 (p < 0.05), or in the ventral intermediate nucleus of the thalamus, HR=0.42 (p < 0.05) compared to implantation in the globus pallidus. High amplitude settings significantly increased the likelihood of requiring battery replacement, HR=3.353 (p < 0.05). Diagnosis necessitating DBS placement, UPDRS score (for patients with Parkinson’s disease), demographic factors and battery model were not statistically significantly associated with battery longevity.

Conclusion : Our findings suggest that battery longevity can be optimized by considering anesthesia type at time of implantation, anatomic target choice and favoring low amplitude settings, whenever possible. Increasing battery longevity could reduce the number of procedures patients have to undergo, thereby decreasing overall healthcare costs and adverse outcomes (e.g. infection) associated with repeated battery replacements.