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.

Background and Purpose Systemic Inflammatory Response (SIRS) is a generalized inflammatory state. The primary goal of the study was to determine if differences exist in outcomes in SIRS and non-SIRS IV tPA treated patients. Methods Consecutive patients were retrospectively reviewed for evidence of SIRS during their admission. SIRS was defined as the presence of two or more: body temperature <36° C or >38° C, HR >90, respiratory rate >20 and WBC <4,000/mm or >12,000mm or >10% bands. Patients diagnosed with infection (via positive culture) were excluded. Results Out of 241 patients, 44 had evidence of SIRS (18%). Adjusting for pre-tPA NIHSS, age, and race, SIRS remained a predictor of poor functional outcome at discharge (OR= 2.58, 95% CI, 1.16 – 5.73, p=0.0197). Conclusion In our sample of tPA treated patients, almost 1 out of 5 patients developed SIRS. Further, we found the presence of SIRS to be associated with poor short-term functional outcomes and prolonged length of stay.

Background Deep brain stimulation is an effective treatment for movement disorders, but it is relatively complex, invasive, and costly. Little is known about whether stimulation mode alters pulse generator (battery) longevity in routine clinical care. Objective To compare battery longevity during monopolar versus bipolar stimulation in patients who underwent deep brain stimulation for movement disorders. Methods We evaluated 2,902 programming adjustments and calculated the average stimulator settings for 393 batteries in 200 unique patients with Parkinson's disease and essential tremor. We classified the pulse generators into different stimulation modes (monopolar, bipolar, tripolar, double monopolar) and compared battery longevity with Kaplan Meier survival analyses using the log rank test. We exclusively implanted the Medtronic 3387 lead with adjacent electrode contacts separated by 1.5 mm. Results The mean pulse generator longevity was 47.6±1.6 months regardless of diagnosis or stimulation mode. Bipolar stimulation mode was associated with greater longevity than monopolar stimulation (56.1±3.4 versus 44.2±2.1 months, p=0.006). This effect was most pronounced when stimulation parameters were at low to moderate intensity settings. Double monopolar configuration was associated with less pulse generator longevity than conventional stimulation modes (37.8±5.6 versus 49.7±1.9, p=0.014). Conclusion IPGs initially programmed in bipolar mode provided one year of additional battery longevity versus monopolar mode in this large retrospective series of patients with essential tremor and Parkinson's disease. Given satisfactory efficacy for motor symptoms, bipolar stimulation mode is a feasible alternative programming strategy at the initiation of DBS therapy.

Hepatocrinology is defined as a bidirectional, complex relationship between hepatic physiology and endocrine function, hepatic disease and endocrine dysfunction, hepatotropic drugs and endocrine function, and endocrine drugs and hepatic health. The scope of hepatocrinology includes conditions of varied etiology (metabolic, infectious, autoimmune, and invasive) that we term as hepato-endocrine syndromes. This perspective shares the definition, concept, and scope of hepatocrinology and shares insight related to this aspect of medicine. It is hoped that this communication will encourage further attention and research in this critical field.

Background Systemic inflammatory response syndrome (SIRS) is an inflammatory process associated with poor outcomes in acute ischemic stroke (AIS) patients. However, no study to date has investigated predictors of SIRS in AIS patients treated with intravenous (IV) tissue plasminogen activator (tPA). Methods Consecutive patients were retrospectively reviewed for evidence of SIRS during their acute hospitalization. SIRS was defined as the presence of 2 or more of the following: (1) body temperature less than 36°C or greater than 38°C, (2) heart rate greater than 90, (3) respiratory rate greater than 20, or (4) white blood cell count less than 4000/mm or greater than 12,000/mm or more than 10% bands for more than 24 hours. Those diagnosed with an infection were excluded. A scoring system was created to predict SIRS based on patient characteristics available at the time of admission. Logistic regression was used to evaluate potential predictors of SIRS using a sensitivity cutoff of ≥65% or area under the curve of .6 or more. Results Of 212 patients, 44 had evidence of SIRS (21%). Patients with SIRS were more likely to be black (61% versus 54%; P = .011), have lower median total cholesterol at baseline (143 versus 167 mg/dL; P = .0207), and have history of previous stroke (51% versus 35%; P = .0810). Ranging from 0 to 6, the SIRS prediction score consists of African American (2 points), history of hypertension (1 point), history of previous stroke (1 point), and admission total cholesterol less than 200 (2 points). Patients with an SIRS score of 4 or more were 3 times as likely to develop SIRS when compared with patients with a score of ≤3 (odds ratio = 2.815, 95% confidence interval 1.43–5.56, P = .0029). Conclusions In our sample of IV tPA-treated AIS patients, clinical and laboratory characteristics available on presentation were able to identify patients likely to develop SIRS during their acute hospitalization. Validation is required in other populations. If validated, this score could assist providers in predicting who will develop SIRS after treatment with IV tPA.