Note to reader: Keep in mind, this article was written in 2016. DBS batteries are changing and last longer than they did when the article was written just a few years ago!
Decision-making isn’t easy, especially when your health is at stake. After you decide to have Deep Brain Stimulation, you select whether to go for unilateral or bilateral surgery, followed by a choice of battery type. Your options are a rechargeable or a non-rechargeable battery.
With a non-rechargeable battery, you live free from tremor until your battery runs out. You’ll have surgery to replace the battery approximately every 3-5 years, but some people need to replace it in much less time. Like Cinderella in her gown and glass slippers, you must be mindful that that your non-rechargeable battery-life has a timeframe for replacement. With the same authority as Fairy Godmother, your neurostimulator settings determine how quickly they deplete your battery.
A rechargeable battery will last for 9 years, but you must charge it pretty much daily.
There is no right answer. A case can be made for either decision. Ultimately, you must make the choice yourself.
Cost Difference Between Rechargeable and Non-rechargeable Batteries
As a matter of interest, a rechargeable battery is a more expensive battery whereas a non-rechargeable battery is less expensive. The price difference varies greatly depending on the hospital. This is based on national or regional hospital contracts, hospital volume, bulk orders, etc. Also, this is not necessarily the price patients will see on their bill as hospitals and insurers tend to have their mark up as well. A rechargeable dual channel costs around three times more than a single channel non-rechargeable, and a primary cell non-rechargeable dual channel is somewhere in the middle of those two figures.
Bay Area Choices
In the Bay Area, Kaiser Permanente gives you a choice between rechargeable and non-rechargeable batteries. My movement disorder specialist Dr. Rima Ash said, “People often don’t choose rechargeable due to the ordeal of charging, athough, for most, it is a simple activity that takes about 20-30 min if done daily. Medtronic has now come out with better ways to charge without having to use the recharging harness.”
Dr. Helen Bronte-Stewart. MD, MSE, FANN, FANA, Director of the Stanford Comprehensive Movement Disorders Center said, “My patients with the rechargeable are doing well with it and charge it every night/day. The majority of them have dystonia, which is where we use it more frequently as they require IPG replacements more often.”
If you research online, you will read that UCSF doesn’t recommend rechargeable unless you are using up your existing system in less than 2 years from implantation. “This is not a hard and fast rule at UCSF,” said Monica Volz, a nurse practitioner at UCSF Movement Disorders and Neuromodulation Center. “We have some patients who have some signs of dementia or other mental conditions, where even if they were going through their battery in less than two years, UCSF would recommend non-rechargeable replacements. It really just depends. The pros and cons are discussed with every patient before replacement.”
Sometimes implanters will put a non-rechargeable a little deeper because of the patient’s anatomy, but then if a patient would switch to a rechargeable it may be too deep to obtain excellent coupling. This would be a complication that would require a pocket revision and swallowing of the pocket. This would usually be done at the time of replacement but something to consider for some patients.
Difference in Ease of Using
- Dr. Eric Sabelman, Senior Bioengineer in Functional Neurosurgery at Kaiser Permanente-Redwood City points out: with rechargeable batteries, DBS patients might have trouble positioning the recharging coil which can be difficult for a person with impaired arm and hand function.
- There is a “sweet spot” that some users have difficulty locating in order for the charge to be successful.
- Some patients choose non-rechargeable because they don’t want to deal with charging.
- You may be attracted to a non-rechargeable battery because your family life and lifestyle put such stress on you that you can’t tolerate another daily task.
- If you’re traveling abroad you must carry an adaptor with you for recharging. “Be sure to recharge conservatively early on when traveling,” suggests physician-assistant Ivan Bernstein at Kaiser-Permanente Redwood City.
Difference in Number of Hospital Visits
Some doctors prefer rechargeable because it reduces the number of surgeries you will have with the shorter life non-rechargeable battery.
A side benefit of the non-rechargeable battery is that it assures you that every 3–5 years you will get a comprehensive re-evaluation and technology match reassessment. Who knows what kind of equipment they’ll come up with tomorrow? Movement Disorder Specialist Rima Ash noted that “waiting may allow a for better technology with the next battery.”
What my doctors and medical professionals suggested
In my case, most of the doctors and professionals I asked, suggested a rechargeable battery to reduce surgeries, because my battery had to be replaced at 2.9 years, which is shorter than the average time of 3 to 5 years. Dr. Ash said, “We [at Kaiser Permanente] typically suggest rechargeable for those who drain their battery under 2-3 years.”
My neurosurgeon cautioned, “Whenever there’s hesitation about rechargeable, I think it should be avoided,” reminding me that the rechargeable model needs daily attention.
What my friends suggested
Most of my friends and family voted on the non-rechargeable battery. My brother commiserated, “Another task? I can barely remember to brush my teeth!” My sister concurred, “Our family doesn’t like to sit for daily recharges. Non-rechargeable sounds hassle free and uncomplicated.”
A friend with PD said, “I would go for the non-rechargeable just for the travel issues – on our African safari, for example, power was not consistent. I’d probably go for replacement in 3 years and see what advances they make in that time period.”
Another friend thought the non-rechargeable wins the cost-benefit calculation. He said, “Daily charging is an ordeal and could likely prove overbearing. Moreover, the surgery for a charge-free battery has an extraordinarily high success/no complications rate.” One of my friends preferred the chargeable stimulator because “you’ll have 3 less surgeries less with a rechargeable battery.”
What did I choose?
As a friend pointed out, “Get all the opinions and then go with your gut. You alone know what is best for you!” On that advice, I chose the non-rechargeable for some of the reasons above. The quest for freedom swayed my decision.
I returned to work a week after the surgery. The surgery isn’t bad, but it is not easy. There are plenty of reasons—such as the irritation of the skin around the stitches, the care to protect the wound area, the time off work, and the short life of the battery that may steer me towards the rechargeable battery next time, since I will be revisiting this decision again in 2.9 years.
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