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Change in deep brain stimulation effect in Parkinson's disease after replacement with a new generation neurostimulator

Rouleau, E. A. M. Y.; van der Gaag, S.; Keulen, B. J.; Scholten, M. N.; Beudel, M.; ten Kate, J. M.; Verkaart, S. J. E.; Kuijf, M. L.; Tjepkema-Cloostermans, M. C.; van Veen, E.; de Ronde, E. M.; Esselink, R. A. J.; van Zwet, E. W.; Hoffmann, C. F. E.; van Essen, T. A.; van der Gaag, N. A.; Zutt, R.; Contarino, M. F.

2026-05-03 neurology
10.64898/2026.05.01.26352067 medRxiv
Show abstract

Parkinsons disease patients may experience a different therapeutic effect after replacement of the Medtronic Activa(R) deep brain stimulation neurostimulator with the newer Percept model, which features multiple independent current sources and constant-current control. We analyzed patient-reported therapeutic effect changes after Activa(R)-to-Percept replacements (AP, n=52) across six Dutch DBS-centers, comparing appropriate (AP+, n=36) and inappropriate/no (AP-, n=16) use of the manufacturers replacement workflow. Previous Activa(R)-to-Activa(R) replacements (AA, n=69) were used as reference. Worsened therapeutic effect was reported in 75.0% of AP-, 44.4% of AP+, and 21.7% of AA replacements (p<0.001). In the AP group, most patients with worsened effect were previously programmed with constant-voltage. Concluding, the risk of worsened therapeutic effect following AP replacements is higher compared to AA replacements, in particular when the replacement workflow is not properly used or in complex electrode configurations. We advise to use the workflow, inform the patient and plan closer follow-up appointments.

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