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Background: Subthalamic nucleus (STN) deep brain stimulation (DBS) alleviates severe motor fluctuations and dyskinesia in Parkinson's disease, but may result in speech and gait disorders. Among the suspected or demonstrated causes of these adverse effects, we focused on the topography of contact balance (CB; individual, right and left relative dual positions), a scantly studied topic, analyzing the relationships between symmetric or non-symmetric settings, and the worsening of these signs. Method: An observational monocentric study was conducted on a series of 92 patients after ethical approval. CB was specified by longitudinal and transversal positions and relation to the STN (CB sub-aspects) and totalized at the patient level (patient CB). CB was deemed symmetric when the two contacts were at the same locations relative to the STN. CB was deemed asymmetric when at least one sub-aspect differed in the patient CB. Baseline and 1-year characteristics were routinely collected: (i) general, namely, Unified Parkinson's Disease Rating Scores (UPDRS), II, III motor and IV, daily levodopa equivalent doses, and Parkinson's Disease Questionnaire of Quality of Life (PDQ39) scores; (ii) specific, namely scores for speech (II-5 and III-18) and axial signs (II-14, III-28, III-29, and III-30). Only significant correlations were considered (p < 0.05). Results: Baseline characteristics were comparable (symmetric versus asymmetric). CB settings were related to deteriorations of speech and axial signs: communication PDQ39 and UPDRS speech and gait scores worsened exclusively with symmetric settings; the most influential CB sub-aspect was symmetric longitudinal position. Conclusion: Our findings suggest that avoiding symmetric CB settings, whether by electrode positioning or shaping of electric fields, could reduce worsening of speech and gait. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to create a new version of the French GTS-QOL adapted to adolescents with GTS aged 12–16 years (GTS-QOL-French-Ado) and to evaluate its psychometric properties. Methods: We assessed the psychometric properties of the GTS-QOL-French-Ado in 84 adolescents (mean age 13.6 years, standard deviation 1.2) in terms of factor structure, internal consistency, reliability and convergent validity with the Child Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC), the Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey (MOVES) and the French "Vécu et Santé Perçue de l'Adolescent" (VSP-A), a generic self-administered measure of health-related quality of life (HRQoL) in adolescents. Results: Exploratory factor analysis of the GTS-QOL-French-Ado resulted in a 5-factor solution. The GTS-QOL-French-Ado demonstrated good acceptability with missing values per subscale ranging from 0% to 1.2%, good internal consistency for four of the five subscales with Cronbach's alpha ranging from 0.56 to 0.87 and good test–retest reliability with intraclass correlation coefficients ranging from 0.74 (95% CI: 0.52–0.86) to 0.82 (95% CI: 0.66–0.91). Convergent validity was supported by correlations with CDI, MASC, MOVES, VSP-A and clinical variables. Discussion: The GTS-QOL-French-Ado is the first disease-specific HRQoL tool for French-speaking adolescents with GTS aged 12–16 years, and shows good psychometric properties. Further psychometric testing on responsiveness to change would be of great interest. [ABSTRACT FROM AUTHOR]

Introduction: The Gilles de la Tourette Syndrome–Quality of Life Scale (GTS-QOL) is a self-rated disease-specific questionnaire to assess health-related quality of life of subjects with GTS. Our aim was to perform the cross-cultural adaptation of the GTS-QOL into French and to assess its psychometric properties. Methods: The GTS-QOL was cross-culturally adapted by conducting forward and backward translations, following international guidelines. The psychometric properties of the GTS-QOL-French were assessed in 109 participants aged 16 years and above with regard to factor structure, internal consistency, reliability and convergent validity with the MOVES (Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey) and the WHOQOL-BREF (World Health Organization Quality of Life Brief). Results: Exploratory factor analysis of the GTS-QOL-French resulted in a 6-factor solution and did not replicate the original structure in four subscales. The results showed good acceptability (missing values per subscale ranging from 0% to 0.9%), good internal consistency (Cronbach's alpha ranging from 0.68 to 0.94) and good test–retest reliability (intraclass correlation coefficients ranging from 0.70 to 0.81). Convergent validity with the MOVES and WHOQOL-BREF scales showed high correlations. Discussion: Our study provides evidence of the good psychometric properties of the GTS-QOL-French. The cross-cultural adaptation and validation of this specific instrument will make it possible to assess health-related quality of life in French-speaking subjects with GTS. The GTS-QOL-French could be recommended for use in future research. [ABSTRACT FROM AUTHOR]

Introduction: Whether different mechanisms, particularly ocular pathology, could lead to the emergence of visual hallucinations (VH) (defined as false perceptions with no external stimulus) versus visual illusions (VI) (defined as a misperception of a real stimulus) in Parkinson's disease (PD) remains debated. We assessed retinal, clinical and structural brain characteristics depending on the presence of VH or VI in PD. Methods: In this case–control study, we compared retinal thickness using optical coherence tomography (OCT), between PD patients with: VI (PD-I; n = 26), VH (PD-H; n = 28), and without VI or VH (PD-C; n = 28), and assessed demographic data, disease severity, treatment, anatomical and functional visual complaints, cognitive and visuo-perceptive functions and MRI brain volumetry for each group of PD patients. Results: Parafoveal retina was thinner in PD-H compared to PD-C (p = 0.005) and PD-I (p = 0.009) but did not differ between PD-I and PD-C (p = 0.85). Multivariate analysis showed that 1/retinal parafoveal thinning and total brain gray matter atrophy were independently associated with the presence of VH compared to PD-I; 2/retinal parafoveal thickness, PD duration, sleep quality impairment and total brain gray matter volume were independent factors associated with the presence of VH compared to PD-C; 3/anterior ocular abnormalities were the only factor independently associated with the presence of illusions compared to PD-C. Conclusion: These findings reinforce the hypothesis that there may be different mechanisms contributing to VH and VI in PD, suggesting that these two entities may also have a different prognosis rather than simply lying along a continuous spectrum. Registration number: Clinicaltrials.gov number NCT01114321. [ABSTRACT FROM AUTHOR]

We investigated whether pre-operative MRI measures of focal brain atrophy could predict cognitive decline occurring after deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with Parkinson’s disease (PD). For that purpose, we prospectively collected data of 42 consecutive patients with PD who underwent bilateral STN-DBS. Normalized brain structure volumes and cortical thicknesses were measured on pre-operative T1-weighted MRI. Patients were tested for their cognitive performances before surgery and 1 year after. After controlling for age, gender, pre-operative disease severity, change in dopaminomimetic dose after surgery and contact location, we found correlations: (1) between the variation of the total Mattis dementia rating scale (MDRS) score and left lateral ventricle volume (p = 0.032), (2) between the variation of the initiation/perseveration subscore of the MDRS and the left nucleus accumbens volume (p = 0.042) and the left lateral ventricle volume (p = 0.017) and (3) between the variation of the backward digit-span task and the right and left superior frontal gyrus thickness (p = 0.004 and p = 0.007, respectively). Left nucleus accumbens atrophy was associated with decline in the initiation/perseveration subscore with the largest effect size (d = − 1.64). Pre-operative left nucleus accumbens volume strongly predicted postoperative decline in the initiation/attention subscore (AUC = 0.92, p < 0.001, 96.3% sensitivity, 80.0% specificity, 92.9% PPV and 92.9% NPV). We conclude that the morphometric measures of brain atrophy usually associated with cognitive impairment in PD can also explain or predict a part of cognitive decline after bilateral STN-DBS. In particular, the left accumbens nucleus volume could be considered as a promising marker for guiding surgical decisions. [ABSTRACT FROM AUTHOR]

Introduction: The Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey (MOVES) is a self-report scale suggested as a severity scale for tics and related sensory phenomena observed in Gilles de la Tourette syndrome (GTS) and recommended as a screening instrument by the Committee on Rating Scale Development of the International Parkinson’s Disease and Movement Disorder Society.Objectives: To cross-culturally adapt a French version of the MOVES and to evaluate its psychometric properties.Methods: After the cross-cultural adaptation of the MOVES, we assessed its psychometric properties in 53 patients aged 12-16 years and in 54 patients aged 16 years and above: reliability and construct validity (relationships between items and scales), internal consistency and concurrent validity with the Yale Global Tic Severity Scale (YGTSS) and the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) or the auto-Yale-Brown scale.Results: The results showed very good acceptability with response rates greater than 92%, good internal consistency (Cronbach’s alpha ranging from 0.62 and 0.89) and good test-retest reliability (ICCs ranging from 0.59 to 0.91). Concurrent validity with the YGTSS, CY-BOCS and auto-Yale-Brown scales showed strong expected correlations. The cut-off points tested for diagnostic performance gave satisfactory values of sensitivity, specificity, and positive and negative predictive values.Discussion: Our study provides evidence of the good psychometric properties of the French version of the MOVES. The cross-cultural adaptation of this specific instrument will allow investigators to include French-speaking persons with GTS aged 12 years and over in national and international collaboration research projects. [ABSTRACT FROM AUTHOR]

Background: Deep brain stimulation (DBS) in Parkinson's disease uses bi-hemispheric high-frequency stimulation within the subthalamus, however, the specific impacts of bilaterality of DBS are still not clear. Thus, we aimed to study the individual-level clinical impact of locations of right-left contact pair-up accounting for each subthalamic nucleus (STN) anatomy. Methods: Contact locations and effects at 1 year were studied retrospectively in an unselected series of 53 patients operated between 2004 and 2010. Location of contacts was defined relatively to the main axis of STN used to map longitudinal and transversal positions, and STN membership (out meaning out-of-STN). Contact pairings were described via three methods (i) Unified contact location (UCL) collapsing DBS into an all-in-one contact (ii) balance of contact pair-up (BCPU), defined as symmetric or asymmetric regardless of laterality (iii) hemisphere-wise most frequent contact pair-up (MFCP) regardless of BCPU. Clinical data were mean levodopa equivalent dose, Unified Parkinson's Disease Rating Scale (UPDRS) motor score III without medication, UPDRS II and III speech sub-scores, UPDRS II freezing sub-score, 1 year versus preoperative values, with and without levodopa. Ad-hoc two-sided tests were used for statistical analysis. Results: Worsening speech, was more frequent for UCL_out patients and when the left MFCP contact was rear and or superolateral, however, it less frequent for BCPU-asymmetric patients. Worsening freezing was more frequent when the right MFCP contact was rear and superolateral. Conclusions: These results point to strategies for minimizing dysarthria and freezing as adverse effects of DBS. [ABSTRACT FROM AUTHOR]

Gait disturbances, including freezing of gait, are frequent and disabling symptoms of Parkinson's disease. They often respond poorly to dopaminergic treatments. Although recent studies have shed some light on their neural correlates, their modulation by dopaminergic treatment remains quite unknown. Specifically, the influence of levodopa on the networks involved in motor imagery (MI) of parkinsonian gait has not been directly studied, comparing the off and on medication states in the same patients. We therefore conducted an [H2150] Positron emission tomography study in eight advanced parkinsonian patients (mean disease duration: 12.3 ± 3.8 years) presenting with levodopa-responsive gait disorders and FoG, and eight age-matched healthy subjects. All participants performed three tasks (MI of gait, visual imagery and a control task). Patients were tested off, after an overnight withdrawal of all antiparkinsonian treatment, and on medication, during consecutive mornings. The order of conditions was counterbalanced between subjects and sessions. Results showed that imagined gait elicited activations within motor and frontal associative areas, thalamus, basal ganglia and cerebellum in controls. Off medication, patients mainly activated premotor-parietal and pontomesencephalic regions. Levodopa increased activation in motor regions, putamen, thalamus, and cerebellum, and reduced premotor-parietal and brainstem involvement. Areas activated when patients are off medication may represent compensatory mechanisms. The recruitment of these accessory circuits has also been reported for upper-limb movements in Parkinson's disease, suggesting a partly overlapping pathophysiology between imagined levodopa-responsive gait disorders and appendicular signs. Our results also highlight a possible cerebellar contribution in the pathophysiology of parkinsonian gait disorders through kinesthetic imagery. Hum Brain Mapp 36:959-980, 2015. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

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Objective: Based on a variety of empirical evidence obtained within the theoretical framework of embodiment theory, we considered it likely that motor disorders in Tourette's syndrome (TS) would have emotional consequences for TS patients. However, previous research using emotional facial categorization tasks suggests that these consequences are limited to TS patients with obsessive-compulsive behaviors(OCB). Method: These studies used long stimulus presentations which allowed the participants to categorize the different emotional facial expressions (EFEs) on the basis of a perceptual analysis that might potentially hide a lack of emotional feeling for certain emotions. In order to reduce this perceptual bias, we used a rapid visual presentation procedure. Results: Using this new experimental method, we revealed different and surprising impairments on several EFEs in TS patients compared to matched healthy control participants. Moreover, a spatial frequency analysis of the visual signal processed by the patients suggests that these impairments may be located at a cortical level. Conclusions: The current study indicates that the rapid visual presentation paradigm makes it possible to identify various potential emotional disorders that were not revealed by the standard visual presentation procedures previously reported in the literature. Moreover, the spatial frequency analysis performed in our study suggests that emotional deficit in TS might lie at the level of temporal cortical areas dedicated to the processing of HSF visual information. [ABSTRACT FROM AUTHOR]

Background: Few studies have used standardized QOL instruments to assess the quality of life (QOL) in Gilles de la Tourette Syndrome (GTS) patients. This work investigates the QOL of adult GTS patients and examines the relationships between physical and psychological variables and QOL. Methods: Epidemiological investigation by anonymous national postal survey of QOL of patients of the French Association of Gilles de la Tourette Syndrome (AFGTS) aged 16 years or older. The clinical and QOL measures were collected by four questionnaires: a sociodemographic and GTS-related symptoms questionnaire, the World Health Organization Quality Of Life questionnaire (WHOQOL-26), the Functional Status Questionnaire (FSQ), and a self-rating questionnaire on psychiatric symptoms (SCL-90), all validated in French. We used stepwise regression analysis to explicitly investigate the relationships between physical and psychological variables and QOL domains in GTS. Results: Questionnaires were posted to 303 patients, of whom 167 (55%) completed and returned them. Our results, adjusted for age and gender, show that patients with GTS have a worse QOL than the general healthy population. In particular, the "Depression" psychological variable was a significant predictor of impairment in all WHOQOL-26 domains, psychological but also physical and social. Conclusions: The present study demonstrates a strong relationship between QOL in GTS and psychiatric symptoms, in particular those of depression. [ABSTRACT FROM AUTHOR]

Background: Substance and behavioral addictions have already been described separately or in combination in Parkinson's disease. However, no comparisons of the prevalence of addictive behaviors in patients with Parkinson's disease and the general population have been published. The objective of this study was to compare the prevalence and characteristics of addictions (gambling, hypersexuality, tobacco, and alcohol) in patients with Parkinson's disease and in a matched, paired sample from the general population. Methods: After matching for age, sex, and complete field questionnaires on addictions, we had 115 data sets. Results: No difference was observed between Parkinson's disease and control populations concerning pathological gambling (0.87% vs 0.87%, P = .99), tobacco addiction (1.7% vs 1.7%, P = .99), and alcohol dependence (2.6% vs 3.5%, P = .71). The Parkinson's disease group showed 2 cases of sexual addiction (1.7% vs 0, P = .15). Conclusions: Our results indicate that patients with Parkinson's disease do not have specific profiles for tobacco or alcohol addiction and pathological gambling compared with the general population. © 2011 Movement Disorder Society [ABSTRACT FROM AUTHOR]

Subthalamic nucleus (STN) targeting is classically performed based on AC-PC probabilistic position. Nevertheless, MRI allows direct visualization and targeting. We aimed to compare the position localized on MR images with standard stereotactic diagrams. The STN was manually contoured on MR images (22 Parkinson’s disease patients); boundaries were simplified in a schematic polygonal form. Front and lateral stereotactic diagrams were constructed according to Talairach and Benabid. We compared x, y and z coordinates of the geometrical center of MRI-based polygons and stereotactic diagrams (Wilcoxon matched-pairs tests). There was significant discordance between MRI-based polygons and AC-PC-based images. MRI shows the STN as more posterior, medial and slightly inferior. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Groups performing deep brain stimulation advocate post-operative imaging [magnetic resonance imaging (MRI) or computer tomography (CT)] to analyse the position of each electrode contact. The artefact of the Activa 3389 electrode had been described for MRI but not for CT. We undertook an electrode artefact analysis for CT imaging to obtain information on the artefact dimensions and related electrode contact positions. The electrode was fixed on a phantom in a set position and six acquisitions were run (in-vitro study). The artefacts were compared with the real electrode position. Ten post-operative acquisitions were analysed (in-vivo analysis). We measured: H (height of the lateral black artefact), D (distance between the beginning of the white and the lateral black artefacts) and W (maximal artefact width), representing respectively the lengths of the four contacts and the electrode tip and width of the contact zone. A Student t-test compared the results: in vivo vs in vitro and coronal vs sagittal reconstructions along the electrode. The limits of the lateral black artefact around the electrode contacts corresponded to the final electrode position. There was no significant difference for D (in vivo, 1.1 ± 0.1 mm; in vitro, 1.2 ± 0.2 mm; p = 0.213), while W and H differed slightly (in vivo, W = 3.3 ± 0.2 mm, H = 7.7 ± 0.2 mm; in vitro, W = 3.1 ± 0.1 mm, H = 7.5 ± 0.2 mm). Results obtained with sagittal and coronal reconstructions were similar ( p > 0.6). Precise three-dimensional (3D) localisation of the four-contact zone of the electrode can be obtained by CT identification of the limits of the lateral black artefact. The relative position of the four contacts is deduced from the size of the contacts and the inter-contact distance. Sagittal and coronal reconstructions along the electrode direction should be considered for the identification of the four electrode contacts. CT offers a useful alternative to post-operative MRI. [ABSTRACT FROM AUTHOR]

In deep brain stimulation, the anatomic positions of electrode contact centers are used as the basis for analysis. We propose a new semi-quantitative approach (contact membership concept) considering patient’s individual anatomy, contact size, and extent of involvement of STN and neighboring structures. In ten bilaterally operated and improved Parkinsonian patients, effective contact positions (contacts used for monopolar stimulation) were analyzed. The position of the contact center (classical binary approach: each center assigned, 1, or not, 0, to a given structure) and of the contact in its dimension (contact membership concept: membership degree, ordinal values from 0 to 1, assigned to each anatomic structure according to extent of involvement) were compared for the whole patient group and, individually, for each patient. The membership concept revealed that for 13 out of 20 contacts, more than one structure was involved, where the classical binary approach assigned only one structure. For both approaches lateral STN, zona incerta and H1 (Forel’s Field) were the main structures involved, but their frequencies of appearance differed. The membership concept allows detailed analysis of the anatomic contact position. In the future this approach could assist in correlating anatomy and clinical results for all electrode contacts (effective ones and clinically less efficient ones). [ABSTRACT FROM AUTHOR]

Tardive dystonia (TD) is a disabling disorder induced by neuroleptics. Internal globus pallidus (GPi) stimulation can dramatically improve TD. The present positron emission tomography and H215O study aimed to characterize the abnormalities of brain activation of TD and the impact of GPi stimulation on these abnormalities in five TD patients treated with GPi stimulation and eight controls. Changes of regional cerebral blood flow (rCBF) were determined: (i) at rest; (ii) when moving a joystick with the right hand in three freely chosen directions in on and off bilateral GPi stimulation. A significant increase of rCBF was found in TD patients in off-stimulation condition compared to controls: (1) during motor execution in the prefrontal, premotor lateral, and anterior cingulate cortex; (2) at rest, in the prefrontal and anterior cingulate cortex and the cerebellum. Internal globus pallidus stimulation led to a reduction of rCBF (1) during motor execution, in the primary motor and prefrontal cortex and the cerebellum; (2) at rest, in the primary motor and anterior cingulate cortex and supplementary motor area. The results are as follows: (1) TD is related to an excess of brain activity notably in the prefrontal and premotor areas; (2) GPi stimulation reduces the activation of motor, premotor, and prefrontal cortex as well as cerebellum.Journal of Cerebral Blood Flow & Metabolism (2008) 28, 1127–1138; doi:10.1038/sj.jcbfm.9600610; published online 30 January 2008 [ABSTRACT FROM AUTHOR]

Object Relationships between clinical effects, anatomy, and electrophysiology are not fully understood in DBS of the subthalamic region in Parkinson’s disease. We proposed an anatomic study based on direct image-guided stereotactic surgery with a multiple source data analysis. Materials and Methods A manual anatomic mapping was realized on coronal 1.5-Tesla MRI of 15 patients. Biological data were collected under local anesthesia: the spontaneous neuron activities and the clinical efficiency and the appearance of adverse effects. They were related to relevant current values (mA), the benefit threshold (bt, minimal current leading an clear efficiency), the adverse effect threshold (at, minimal current leading an adverse effect) and the stimulation margin (sm = at − bt); they were matched with anatomy. Results We found consistent relationships between anatomy and biological data. The optimal stimulation parameters (low bt + high sm) were noted in the dorsolateral STN. The highest spontaneous neuron activity was found in the ventromedial STN. Dorsolateral (sensorimotor) STN seems the main DBS effector. The highest spontaneous neuron activity seems related to the anterior (rostral) ventromedial (limbic) STN. Conclusion 1.5 Tesla images provide sufficiently detailed subthalamic anatomy for image-guided stereotactic surgery and may aid in understanding DBS mechanisms. [ABSTRACT FROM AUTHOR]

The article presents the results of a study that assessed the efficacy of bilateral deep brain stimulation of the internal part of the globus pallidus to treat severe tardive dyskinesia (TD). TD is a common and potentially disabling disorder induced by the use of antipsychotic drugs. A prospective phase 2 multicenter study was conducted. The Extrapyramidal Symptoms Rating Scale decreased compared with baseline at six months after surgery.

Background Although visual hallucinations in Parkinson's disease (PD) have been described in several major studies, little is known about olfactory hallucinations (OHs). Methods The authors performed a detailed analysis of OHs in a cohort of 87 Parkinsonian patients to estimate the prevalence of OHs and describe their phenomenology. They also evaluated smelling abilities in terms of detection and identification. Assessment of both, OHs and olfactory function, was also performed using a control group of 40 normal subjects. Results Nine patients exhibited OHs compared with none of the controls, giving a prevalence of 10% for OHs in patients. OHs were described as rare, short-lasting, unpleasant odours which are not frightening since clearly identified by the patient as hallucinations. Parkinsonian patients with OHs exhibited olfactory impairment of detection and identification compared with controls, but there was no difference in their olfactory abilities from Parkinsonian patients without OHs. Conclusions In conclusion, OHs should be added to the list of non-motor PD symptoms that can occur early or late in the course of PD. The authors' study did not reveal any significant difference in terms of olfactory abilities between patients with or without OHs. However, olfactory impairment is well documented in Parkinsonian patients and cannot be totally ruled out as a risk factor for OHs. The authors recognise that complex mechanisms are probably involved in this phenomenon. [ABSTRACT FROM AUTHOR]

Routine clinical practice of Deep Brain Stimulation (DBS) enters a new era where battery-related events are challenging. The important number of primary implantations and replacements pushed industrials to develop new generations of devices. We aimed to analyze the battery lifetime of different kinds of non-rechargeable devices, manufactured by a single company (Medtronic, USA): the first generation of 4-contact neurostimulator for one DBS-lead (1 channel; Soletra®) and 8-contact neurostimulator for two DBS-leads (two channels of 4 contacts; Kinetra®); the second generation of advanced programming neurostimulator (Activa® PC, two channels of 8 contacts, and SC, 1 channel of 8 contacts). We retrospectively reviewed 281 consecutive patients operated on in a single institution (from 1995 to 2016): 584 surgeries for primary implantation or replacement of neurostimulator (infection and traumatic etiologies of battery replacement were excluded). The battery lifetime was defined as the period between the surgical implantation and the removal at battery depletion. Two hundred and eighty eight battery-lifetimes were analyzed in 157 patients suffering of Parkinson disease (n=129), essential tremor (n=19), dystonia (n=9). Exclusion criteria were: battery related, still operational (n=217); patient related, died before battery depletion (n=50); missing follow-up (n=3); and other diseases treated by DBS (n=2). Battery lifetime was analyzed using survival methods (univariate, Log-Rank test; multivariate, marginal cox model; two-sided tests) accounting for the following parameters: gender, neurological disease, age at the primary implantation, the UPDRS-score before DBS surgery, the deep brain target, battery model, mean voltage (low < 2V; usual from 2V to 4V; high v> 4V), location of battery (abdominal or sub clavicular) and presence of an adapter for replacement of first generation (Kinetra or Soletra) by second generation model (Activa).Results: The battery lifetime was shorter in male (p=0.03) and young (p<0.001) patients suffering of essential tremor (p<0.001) and dystonia (p<0.001). High voltage reduced battery lifetime (p<0.001). The second generation device, Activa models, had shorter lifetime than first generation, Soletra and Kinetra (p<0.001). Replacement of battery decreased lifetime independently of models (p<0.001). Patient and disease characteristics, high voltage, second generation devices and replacement seem to shorten lifetime of battery. [ABSTRACT FROM AUTHOR]