Introduction: The success of deep brain stimulation (DBS) treatment depends on several factors, including proper patient selection, accurate electrode placement, and adequate stimulation settings. Another factor that may impact long-term satisfaction and therapy outcomes is the type of implantable pulse generator (IPG) used: rechargeable or non-rechargeable. However, there are currently no guidelines on the choice of IPG type. The present study investigates the current practices, opinions, and factors DBS clinicians consider when choosing an IPG for their patients. Methods: Between December 2021 and June 2022, we sent a structured questionnaire with 42 questions to DBS experts of two international, functional neurosurgery societies. The questionnaire included a rating scale where participants could rate the factors influencing their choice of IPG type and their satisfaction with certain IPG aspects. Additionally, we presented four clinical case scenarios to assess preference of choice of IPG-type in each case. Results: Eighty-seven participants from 30 different countries completed the questionnaire. The three most relevant factors for IPG choice were “existing social support,” “cognitive status,” and “patient age.” Most participants believed that patients valued avoiding repetitive replacement surgeries more than the burden of regularly recharging the IPG. Participants reported that they implanted the same amount of rechargeable as non-rechargeable IPGs for primary DBS insertions and 20% converted non-rechargeable to rechargeable IPGs during IPG replacements. Most participants estimated that rechargeable was the more cost-effective option. Conclusion: This present study shows that the decision-making of the choice of IPG is very individualized. We identified the key factors influencing the physician’s choice of IPG. Compared to patient-centric studies, clinicians may value different aspects. Therefore, clinicians should rely not only on their opinion but also counsel patients on different types of IPGs and consider the patient’s preferences. Uniform global guidelines on IPG choice may not represent regional or national differences in the healthcare systems.

Keywords:
Deep brain stimulation, Movement disorders, Neurostimulation, Rechargeable implantable pulse generator, Neuromodulation
1.
Vetkas A, Fomenko A, Germann J, Sarica C, Iorio-Morin C, Samuel N, et al. Deep brain stimulation targets in epilepsy: systematic review and meta-analysis of anterior and centromedian thalamic nuclei and hippocampus. Epilepsia. 2022;63(3):513–24.
2.
Mar-Barrutia L, Real E, Segalás C, Bertolín S, Menchón JM, Alonso P. Deep brain stimulation for obsessive-compulsive disorder: a systematic review of worldwide experience after 20 years. World J Psychiatry. 2021;11(9):659–80.
3.
Israeli-Korn SD, Fay-Karmon T, Tessler S, Yahalom G, Benizri S, Strauss H, et al. Decreasing battery life in subthalamic deep brain stimulation for Parkinson’s disease with repeated replacements: just a matter of energy delivered? Brain Stimul. 2019;12(4):845–50.
4.
Niemann M, Schneider GH, Kühn A, Vajkoczy P, Faust K. Longevity of implantable puls e generators in bilateral deep brain stimulation for movement disorders. Neuromodulation. 2018;21(6):597–603.
5.
Helmers AK, Lübbing I, Deuschl G, Witt K, Synowitz M, Mehdorn HM, et al. Comparison of the battery life of nonrechargeable generators for deep brain stimulation. Neuromodulation. 2018;21(6):593–6.
6.
Hitti FL, Vaughan KA, Ramayya AG, McShane BJ, Baltuch GH. Reduced long-term cost and increased patient satisfaction with rechargeable implantable pulse generators for deep brain stimulation. J Neurosurg. 2018;131(3):799–806.
7.
Niemann M, Schneider GH, Kühn A, Vajkoczy P, Faust K. Clinical efficacy of bilateral deep brain stimulation does not change after implantable pulse generator replacement but the impedances do: a prospective study. Neuromodulation. 2020;23(4):530–6.
8.
Wirth T, Laurencin C, Berthillier J, Brinzeu A, Polo G, Simon E, et al. Feasibility of changing for a rechargeable constant current neurostimulator in Parkinson’s disease. Rev Neurol. 2021;177(3):283–9.
9.
Sarica C, Iorio-Morin C, Aguirre-Padilla DH, Najjar A, Paff M, Fomenko A, et al. Implantable pulse generators for deep brain stimulation: challenges, complications, and strategies for practicality and longevity. Front Hum Neurosci. 2021;15:708481.
10.
Furlanetti L, Raslan A, Khaleeq T, Hasegawa H, Tambirajoo R, Samuel M, et al. Fixed-life or rechargeable battery for deep brain stimulation: a prospective long-term study of patient’s preferences. Stereotact Funct Neurosurg. 2020;98(1):43–7.
11.
Soh D, Lozano AM, Fasano A. Hybrid deep brain stimulation system to manage stimulation-induced side effects in essential tremor patients. Parkinsonism Relat Disord. 2019;58:85–6.
12.
Wolf ME, Klockziem M, Majewski O, Schulte DM, Krauss JK, Blahak C. Implementation of new technology in patients with chronic deep brain stimulation: switching from non-rechargeable constant voltageto rechargeable constant current stimulation. Stereotact Funct Neurosurg. 2019;97(5–6):362–8.
13.
Jakobs M, Helmers AK, Synowitz M, Slotty PJ, Anthofer JM, Schlaier JR, et al. A multicenter, open-label, controlled trial on acceptance, convenience, and complications of rechargeable internal pulse generators for deep brain stimulation: the Multi Recharge Trial. J Neurosurg. 2020;133(3):821–9.
14.
Mitchell KT, Volz M, Lee A, San Luciano M, Wang S, Starr PA, et al. Patient experience with rechargeable implantable pulse generator deep brain stimulation for movement disorders. Stereotact Funct Neurosurg. 2019;97(2):113–9.
15.
Helmers AK, Lübbing I, Birkenfeld F, Witt K, Synowitz M, Mehdorn HM, et al. Complications of impulse generator exchange surgery for deep brain stimulation: a single-center, retrospective study. World Neurosurg. 2018;113(5):e108–12.
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