title: Shorter pulse generator longevity and more frequent stimulator adjustments with pallidal DBS for dystonia versus other movement disorders.
abstract: BACKGROUND
  Deep brain stimulation has become a routine therapy for movement disorders, but it is relatively invasive and costly. Although stimulation intensity relates to battery longevity, less is known about how diagnosis and stimulation target contribute to this clinical outcome. Here we evaluate battery longevity in movement disorders patients who were treated at a tertiary referral center.
  
  
  OBJECTIVE
  To compare single channel pulse generator longevity in patients with movement disorders.
  
  
  METHODS
  With Institutional Review Board approval, we evaluated 470 consecutive Soletra implants for routine care. Battery longevity was estimated with Kaplan-Meier analyses, and group comparisons were performed with the log rank mean test. The frequency of clinic encounters for ongoing care was evaluated across diagnoses with analysis of variance (ANOVA).
  
  
  RESULTS
  The mean pulse generator longevity was 44.9 ± 1.4 months. Pallidal DBS for dystonia was associated with shorter battery longevity than subthalamic and thalamic DBS for Parkinson's disease and essential tremor (28.1 ± 2.1 versus 47.1 ± 1.8 and 47.8 ± 2.6 months, respectively, mean ± standard error, P < 0.001), and dystonia patients required more frequent clinic visits for routine care (F = 6.0, P = 0.003). Pallidal DBS for Parkinson's disease and thalamic DBS for cerebellar outflow tremor were associated with shorter battery longevity, as well (35.3 ± 4.6 and 26.4 ± 4.3 months, respectively).
  
  
  CONCLUSIONS
  Pallidal DBS for dystonia was associated with shorter battery longevity and more frequent stimulator adjustments versus DBS for Parkinson's disease and essential tremor. Characteristics of the stimulation target and disease pathophysiology both likely contribute to battery longevity in patients with movement disorders.
authors.affiliation: Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Pawan V
authors.initials: PV
authors.lastname: Rawal
authors.affiliation: Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Almeida
authors.affiliation: Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Luke B
authors.initials: LB
authors.lastname: Smelser
authors.affiliation: Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: He
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Barton L
authors.initials: BL
authors.lastname: Guthrie
authors.affiliation: Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: hcwalker@uab.edu.
authors.forename: Harrison C
authors.initials: HC
authors.lastname: Walker
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods*; D004421:Dystonia / Q000503:physiopathology / Q000628:therapy*; D020821:Dystonic Disorders / Q000503:physiopathology / Q000628:therapy; D011211:Electric Power Supplies; D004867:Equipment Design; D020329:Essential Tremor / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005917:Globus Pallidus / Q000503:physiopathology; D006801:Humans; D008297:Male; D009069:Movement Disorders / Q000503:physiopathology / Q000628:therapy; D010300:Parkinson Disease / Q000628:therapy; D012189:Retrospective Studies; D013788:Thalamus / Q000503:physiopathology; D013997:Time Factors
keywords: Deep brain stimulation; Dystonia; Parkinson's disease