Natural history of neuromodulation devices and therapies: a patient-centered survival analysis

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OBJECTIVE

Despite rapid development and expansion of neuromodulation technologies, knowledge about device and/or therapy durability remains limited. The aim of this study was to evaluate the long-term rate of hardware and therapeutic failure of implanted devices for several neuromodulation therapies.

METHODS

The authors performed a retrospective analysis of patients’ device and therapy survival data (Kaplan-Meier survival analysis) for deep brain stimulation (DBS), vagus nerve stimulation (VNS), and spinal cord stimulation (SCS) at a single institution (years 1994–2015).

RESULTS

During the study period, 450 patients underwent DBS, 383 VNS, and 128 SCS. For DBS, the 5- and 10-year initial device survival was 87% and 73%, respectively, and therapy survival was 96% and 91%, respectively. For VNS, the 5- and 10-year initial device survival was 90% and 70%, respectively, and therapy survival was 99% and 97%, respectively. For SCS, the 5- and 10-year initial device survival was 50% and 34%, respectively, and therapy survival was 74% and 56%, respectively. The average initial device survival for DBS, VNS, and SCS was 14 years, 14 years, and 8 years while mean therapy survival was 18 years, 18 years, and 12.5 years, respectively.

CONCLUSIONS

The authors report, for the first time, comparative device and therapy survival rates out to 15 years for large cohorts of DBS, VNS, and SCS patients. Their results demonstrate higher device and therapy survival rates for DBS and VNS than for SCS. Hardware failures were more common among SCS patients, which may have played a role in the discontinuation of therapy. Higher therapy survival than device survival across all modalities indicates continued therapeutic benefit beyond initial device failures, which is important to emphasize when counseling patients.

ABBREVIATIONS DBS = deep brain stimulation; ET = essential tremor; GPi = internal globus pallidus; PD = Parkinson’s disease; SCS = spinal cord stimulation; STN = subthalamic nucleus; Vim = ventral intermediate nucleus; VNS = vagus nerve stimulation.

Downloadable materials

  • Supplementary Table 1 (PDF 388 KB)

Article Information

Correspondence Ahmed M. Raslan: Oregon Health & Science University, Portland, OR. raslana@ohsu.edu.

INCLUDE WHEN CITING Published online April 19, 2019; DOI: 10.3171/2019.2.JNS182450.

Disclosures Dr. Raslan: consultant for Abbott.

© AANS, except where prohibited by US copyright law.

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    Visual representation of how we defined device survival versus therapy survival.

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    Kaplan-Meier analyses of therapy survival (solid lines) versus device survival (dotted lines) for DBS (A), VNS (B), and SCS (C).

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    Kaplan-Meier analyses of all modalities. Survival analyses of devices (A) and therapy (B) are depicted for DBS (black solid line), VNS (black dotted line), and SCS (gray solid line).

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