Battery for deep brain stimulation depletion in Parkinson's Disease and dystonia patients - a systematic review.

INTRODUCTION: Deep brain stimulation (DBS) therapy for Parkinson's Disease (PD) and dystonia is associated with the possibility of both minor and major complications. One possible side effect is the depletion of implantable pulse generator (IPG) battery and the associated sudden recurrence of PD or dystonia symptoms, which can be potentially life-threatening. Delayed or postponed outpatient visits due to COVID -19 may be a risk factor of battery end-of-life consequences. OBJECTIVE: To analyse the clinical outcomes in reported PD and dystonia patients treated with DBS, who, as a result of the sudden depletion of the neurostimulator battery, developed life-threatening symptoms. MATERIALS AND METHODS: The databases of PubMed, Scopus, EMBASE and Google Scholar were searched using pre-established criteria. RESULTS: A total of 244 articles was found, of which 12 met the adopted criteria. Selected papers presented a total of 17 case reports of DBS-treated patients - 11 with PD, and six with dystonia - who had depleted IPG batteries and due to rapid worsening of PD/dystonia symptoms required urgent hospital admission. IPG battery replacement was the only effective treatment in the majority of cases. CONCLUSIONS: IPG battery depletion can result in fatal outcomes. Sudden recurrence of PD or dystonia symptoms in patients treated by DBS can be potentially life-threatening, so scheduling the replacement of a discharged IPG battery should not be postponed. The COVID-19 pandemic should alert staff at emergency, neurology and movement disorders wards not to postpone the visits of patients with an implanted DBS system.

Recommendations for Deep Brain Stimulation Device Management During a Pandemic.

Most medical centers are postponing elective procedures and deferring non-urgent clinic visits to conserve hospital resources and prevent spread of COVID-19. The pandemic crisis presents some unique challenges for patients currently being treated with deep brain stimulation (DBS). Movement disorder (Parkinson's disease, essential tremor, dystonia), neuropsychiatric disorder (obsessive compulsive disorder, Tourette syndrome, depression), and epilepsy patients can develop varying degrees of symptom worsening from interruption of therapy due to neurostimulator battery reaching end of life, device malfunction or infection. Urgent intervention to maintain or restore stimulation may be required for patients with Parkinson's disease who can develop a rare but potentially life-threatening complication known as DBS-withdrawal syndrome. Similarly, patients with generalized dystonia can develop status dystonicus, patients with obsessive compulsive disorder can become suicidal, and epilepsy patients can experience potentially life-threatening worsening of seizures as a result of therapy cessation. DBS system infection can require urgent, and rarely emergent surgery. Elective interventions including new implantations and initial programming should be postponed. For patients with existing DBS systems, the battery status and electrical integrity interrogation can now be performed using patient programmers, and employed through telemedicine visits or by phone consultations. The decision for replacement of the implantable pulse generator to prevent interruption of DBS therapy should be made on a case-by-case basis taking into consideration battery status and a patient's tolerance to potential therapy disruption. Scheduling of the procedures, however, depends heavily on the hospital system regulations and on triage procedures with respect to safety and resource utilization during the health crisis.