Deep brain stimulation and bowstringing: Case report and pathological correlation

Abstract

Deep Brain Stimulation (DBS) is an established surgical therapy for movement disorders, epilepsy and more recently certain psychiatric disorders. The procedure is safe and complications fortunately few. Bowstringing as a complication has not been well documented and is most probably underreported. Bowstringing describes an entity where the subcutaneous electrode extensions running from head to chest cause a sensation of unpleasant tension, pulling and tightness. Patients may even complain of difficulty with turning their head to the contralateral side. This unpleasant feeling may continue to occur even after the removal of DBS extension leads as the cord like scar still remains. The underlying pathological process and why this occurs in a subset of patients is poorly understood. As such, to date in the literature, there are but a few proposed methods to manage bowstringing in DBS patients and certainly no consensus. We present an illustrative case report with histopathological correlation and suggestions for how this complication might be prevented and managed. Keywords: Deep brain stimulation, Bowstringing, Complication, Pseudocapsule