Which is the best DBS device?

Actually, no DBS device has been proven to the best. All DBS devices are very good.

Newer devices provide many additional features. But whether these additional features help patients in the real world is not known.

Let us learn about these issues.

Which companies manufacture Deep Brain Stimulation (DBS) systems?

Earlier, only Medtronic made a Deep Brain Stimulation (DBS) system. Their device is called “Activa”.

Subsequently, two more devices were approved:

1. Abbott – The device is called “Infinity”.
2. Boston Scientific – The device is called “Vercise”.

Is Abbott’s “Infinity” the best DBS device?

There are 2 varieties of the system.

There are 2 additional advantages:
Small size:

The single-channel device (Infinity-5) is the smallest DBS battery available.

But, that is not the most crucial feature of the Infinity system.
More stimulation points:

In the Infinity system, you can select a wire with more stimulation points at the end (up to 8). So, you can give stimulation precisely – to only a small brain part.
Current steering:

The Infinity DBS system can “steer” the electrical current.

It can point the electrical current in a particular direction. So if you want only the right side of the wire to get current, you can do that. Current to the left – you got it!

Here is a video of how this is done. This video mentions the Vercise device (described below), which has similar features:

How can “steering” current help?

This ability is useful when the end of the wire is not exactly in the target.

For example, let us say the target is slightly to the left of the wire. Then, the Infinity device can make the current go more to the left.

It may also help to reduce side-effects.

For example, let us say stimulation is causing hoarseness of voice. The Infinity system can steer current away from the part whose stimulation is causing hoarseness.

So, in theory, this ability should improve movement while at the same time reducing side-effects.

Is Boston Scientific’s “Vercise” the best DBS device?

There are 2 varieties of the system.

There are 4 advantages:
Longevity:

There are two varieties of the Vercise system – rechargeable and non-rechargeable.

The rechargeable Vercise system holds a trump card. You don’t need to replace the battery for a long time! (see below)

More stimulation points:

Same as the Infinity system.
Current steering:

Earlier, the Vercise system was not capable of “steering” current.

In 2019, a newer version of the device (specifically, a newer wire called Cartesia) was approved. This more recent version is capable of steering current.

Are the more expensive Infinity / Vercise DBS devices really better than the older, cheaper Activa DBS device?

No one has done a head-to-head study comparing these devices.

Therefore, we don’t know if one of these devices is better than all others – the “best DBS device”.

My take on it is this:

FOR GPi-DBS:

Medtronic-Activia is the only approved choice.

As noted before, at present, the Infinity & Vercise systems are not approved for GPi-DBS.

For STN DBS:

Both the newer devices are, in general, more expensive than the Medtronic device.

The crucial technical difference is “Current Steering”. The other variables: size & longevity, are usually less important.

Putting the wire perfectly into the STN is not easy. As noted in a previous article, they are like two little peas in the centre of the head.

Neurosurgeons do a phenomenal, near-superhuman task by doing it perfectly most of the time. But sometimes, the lead may be a few millimetres off-target.

Using the Vercise/Infinity devices is planning for a contingency, which rarely arises. If you are monetarily able to do so, you could arrange for this rare contingency.

Which is the best device for DBS?

Both the newer devices are, in general, more expensive than the Medtronic device.

The newer devices are attractive in principle. But, they have not been proven to be more effective than the Medtronic device.

For GPi-DBS, the only choice is Medtronic-Activa system.

For STN-DBS, any of these devices is an excellent choice. For STN-DBS, the doctor usually chooses the device he/she is most comfortable with.

Reference / Further reading:

1. Here is an excellent article about DBS device selection: Okun et al. 2019 – Tips for choosing a DBS device – JAMA Neurology
2. Here is a phenomenal, but very technical, article comparing all DBS devices: Paff et al. 2020 – Update on current technologies for DBS in Parkinson’s disease – Journal of Movement Disorders.

How many years does the battery of Deep Brain Stimulation (DBS) last?

The best DBS device would have a never-ending battery. But, in real-life the DBS battery does run out after some years.

Each of these devices has two varieties: Non-rechargeable & Rechargeable. The non-rechargeable batteries are cheaper. However, they last for a shorter period.

When the battery runs out, the wires inside the head do not need to be replaced. Only the battery below the chest skin is replaced.

So, the battery replacement surgery is much simpler and quicker than the original surgery.

The estimated average life of each of these batteries is noted below.

Non-Rechargeable DBS

Rechargeable DBS

These are estimates. How long your battery will last depends on the strength of stimulation you need (Voltage). The lesser the Voltage required, the longer the battery will last.

Other features of the current (called frequency & pulse width) also affect battery life. But their effect on battery life is less prominent.

Like all DBS-related articles on this website, I am going to sign-off with this picture.

Some of this information may seem complicated. Talk to your doctor to find the best DBS device for you.