Sudden loss of the deep brain stimulation effect with high impedance without macroscopic fracture: a case report and review of the published literature

Abstract

Hui-Jun Yang,1 Ji Young Yun,2 Young Eun Kim,3 Yong Hoon Lim,4 Han-Joon Kim,5 Sun Ha Paek,4 Beom S Jeon5 1Department of Neurology, Ulsan University Hospital, Ulsan, 2Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, 3Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, 4Department of Neurosurgery, Seoul National University Hospital, Seoul, 5Department of Neurology and Movement Disorder Center, Parkinson’s Disease Study Group and Neuroscience Research Institute, Seoul National University Hospital, Seoul, South Korea Abstract: The number of deep brain stimulation (DBS) hardware complications has increased during the past decade. In cases of abnormally high lead impedance with no evidence of a macroscopic fracture, optimal treatment options have not yet been established. Here, we present the case of a 49-year-old woman with a 12-year history of Parkinson’s disease who received bilateral subthalamic nucleus DBS in March 2006. The patient showed good control of parkinsonism until December 24, 2010, when she awoke with abrupt worsening of parkinsonian symptoms. At telemetric testing, lead impedances were found at >2,000 Ω in all four leads on the left side. Fracture of a lead or an extension wire was suspected. However, radiological screening and palpation revealed no macroscopic fracture. In June 2011, the implantable pulse generator (IPG) was changed under local anesthesia without any complications. Postoperatively, her parkinsonism immediately improved to the previous level, and the lead impedance readings by telemetry were also normalized. The disconnection of the neurostimulator connector block and the hybrid circuit board of the IPG was confirmed by destructive analysis. The present report illustrates that a staged approach that starts with simple IPG replacement can be an option for some cases of acute DBS effect loss with high impedance, when radiological findings are normal, thereby sparing the intact electrodes and extension wires. Keywords: connector block, hardware complication, implantable neurostimulators, Parkinson’s disease