title: Fracture of subthalamic nucleus deep brain stimulation hardware as a result of compulsive manipulation: case report.
abstract: OBJECTIVE
  Trichotillomania (TTM) is an impulse control disorder characterized by the recurrent pulling of one's hair resulting in noticeable hair loss. There has been no definite association drawn between Parkinson's disease (PD) and TTM, although there is a suggestion that obsessive-compulsive symptomatology may be more prevalent in left-side predominant PD. We believe that it is important to be aware of psychiatric comorbidities in the surgical treatment of PD, as they may significantly impact the postoperative course.
  
  
  METHODS
  We describe the case of a 58-year-old woman with an eleven-year history of left-side predominant PD who also suffered from TTM. She underwent subthalamic nucleus deep brain stimulation (STN-DBS) and subsequently developed significant wound complications of her left-sided deep brain stimulation leads. It was noted during the postoperative period that the patient was picking her left-sided, but not right-sided, incision-a behavior that was felt to be a part of this patient's impulse control disorder.
  
  
  METHODS
  Multiple wound revisions and eventual replacement of her left-sided deep brain stimulation lead was performed as a result of hardware malfunction secondary to wound manipulation by the patient.
  
  
  CONCLUSIONS
  Before surgery, this patient's TTM was right-sided, but after subthalamic nucleus deep brain stimulation, her wound picking was only left-sided. This case suggests that subthalamic nucleus deep brain stimulation may have a role in unleashing the symptomatology of TTM through an as yet poorly understood mechanism. Furthermore, there is also an implication that the pathophysiology of PD and TTM may be intertwined.
authors.affiliation: The Cleveland Clinic Foundation, Center for Neurological Restoration Cleveland, Ohio 44195, USA.
authors.forename: Andre G
authors.initials: AG
authors.lastname: Machado
authors.forename: Girish K
authors.initials: GK
authors.lastname: Hiremath
authors.forename: Fortino
authors.initials: F
authors.lastname: Salazar
authors.forename: Ali R
authors.initials: AR
authors.lastname: Rezai
mesh_terms: D046690:Deep Brain Stimulation / Q000295:instrumentation*; D020878:Device Removal; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000150:complications* / Q000503:physiopathology*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D019233:Retreatment; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D014256:Trichotillomania / Q000150:complications