Best DBS Device for Parkinson’s in India

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”.

Medtronic
The Medtronic-Activa system has 3 varieties. PC – non-rechargeable. RC-Rechargeable & SC – single channel for one-sided stimulation only.

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.

StJude
The Abbott system has 2 varieties. The larger one (Infinity-7) is for the usual stimulation (both sides of the brain). The smaller one (Infinity-5) can only do one-sided stimulation.

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.

Vercise
Abbot’s Vercise System – The Gevia is rechargeable. The PC model is not rechargeable.

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)

Energizer bunny
Vercise-Gevia is the energizer bunny of DBS-systems. It also has all the other technical features of other systems.

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.

IF the neurosurgeon places the end of the wire perfectly inside the STN, THEN the effect of all devices should be similar.

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.

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Neurosurgeons hit the STN with near-superhuman skill. But they are not infallible.

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.

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Sometimes, choosing is difficult because the differences are minor.

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

Model NumberAverage life span (years)
Medtronic ActivaActiva – PC3 to 5
Abbott InfinityInfinity 5 & 74 to 5
Boston Scientific VerciseVercise – PC3

Rechargeable DBS

Model NumberAverage life span (years)
Medtronic ActivaActiva – RCup to 15
Boston Scientific VerciseGeviaup to 25

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.

Doctor talking to patient about DBS for Parkinson's

Talk to your doctor in detail about your evaluation results, expectations and fears before getting DBS surgery. Image from: freepik.com

Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

Call 022-4897-1800

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NeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar IconNeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar

near LIC, Dr Balabhai Nanavati hospital, near LIC, Swami Vivekananda Road, LIC Colony, Vile Parle

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    Out patient is epileptic from about 10 years and her seizure gotten worse during the past year with the frequency of about 3-4 times a week.So we consulted … More Dr. Kharkar. He tried a few medicines, and within 1.5-2 months now the patient is feeling very well now. There are no seizures for 14 days currently.Dr. tried to keep medicines as minimum as possible. He also tried to keep the cost of the treatment minimum.When some of the medicines started showing side-effects, he was quick to switch the medicines to the better options.Overall I think we are getting a best of the available treatments. We thank you very much Dr. Kharkar.
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    Dr. Kharkar is truly exceptional. He is extremely knowledgeable. But simultaneously, he is extremely patient and kind - taking the time and care to respond … More to all the questions. It is rare to come across a doctor who is not in a hurry to get on to the next patient, but instead, focuses on the one in front with full attention, expertise and compassion. A great experience.
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    One of the best doctors in Mumbai,listen to patients with concern very helpful, takes advise of other doctors very seriously. Examines the disease very … More carefully and advises patient of the medicine accordingly . Over all a good human being.
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    Exceptional experience with an expert,Dr. Kharkar is a knowledge house. It is rare nowadays to find doctors with patience, knowledge, and a flair for … More handling patient’s questions, besides Dr. Kharkar’s bedside manners are exemplary. I am privileged to be treated by such an amazing soul. I have told him and will repeat it here that “I am advancing my move back to India although I am a US Citizen, because I know I am in good hands and will be well taken care of. Thanks Dr. Kharkar for your selfless service!
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    Great doctor!! Really appreciate.The doctor diagnosed to my sister correctly and start treatment, she has good improvement after taking medicine prescribed … More by doctor as no epilepsy attake. We have good experience with the doctor. Thank you
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    We have visited the hospital and meet the Dr. S. Kharkar. And my personal experience is very much better and exilent. My father is very well recover as … More we thought. Thanks to Nanavati Hospital and Dr. S. Kharkar.
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    We had been looking for a specialist in parkinsons for a while now, for my father and when we found Dr. Siddharth Kharka's details on Google, we were … More partly relieved. Partly because, we were all very anxious not knowing how would our visit turn out. I appreciate Dr. Kharkar and his team. He was very clear in his explanations, his knowledge about parkinsons. He took the time to answer the questions we had, went over the diagnosis and started necessary treatment immediately. The only drawback we experienced was the waiting time. Overall, we left the clinic satisfied, knowing much more than when we walked in. We would highly recommend him to anyone looking for a specialist.
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    Hi Sharing my experience with Dr KharkarI had consulted with dr regarding my husband’sProblems of tremors. Dr immediately diagnosed on video consultation … More and could help him to control the tremors s of Parkinson’s disease.I found him genuinely polite and free to talk n patiently listening to the patients problem.Now my husband regained his balance n tremors controlled. Many many thanks to Dr Kharkar
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India Today Magazine - 2021Noted as one of the Best Neurologists in Mumbai