title: Uncoupling of dopaminergic and subthalamic stimulation: Life-threatening DBS withdrawal syndrome.
abstract: BACKGROUND
  Deep brain stimulation (DBS) in therapy for advanced Parkinson's disease (PD) is an accepted treatment. Infections of the system and other complications occasionally result in hardware removal and subsequent medical treatment alone for months.
  
  
  METHODS
  We have analyzed the clinical course of 15 patients requiring removal of at least parts of the DBS system, resulting in a cessation of stimulation.
  
  
  RESULTS
  Most had an uncomplicated return to medical treatment. Three had an unfavorable course during withdrawal, including two deaths. These patients had suffered from PD for more than 18 y and had had DBS for more than 8 y.
  
  
  CONCLUSIONS
  We conclude that DBS withdrawal can be life-threatening, because the whole range of dopaminergic and nondopaminergic medical treatments may be ineffective at this stage. The lack of response to medical treatment might be attributable to advanced disease and long-term changes of the basal ganglia loop in PD.
authors.affiliation: Departments of Neurology, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Kiel, Germany.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Reuter
authors.affiliation: Departments of Neurology, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Kiel, Germany.
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
authors.affiliation: Neurosurgery, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Kiel, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Falk
authors.affiliation: Neurosurgery, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Kiel, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Mehdorn
authors.affiliation: Departments of Neurology, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Kiel, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Witt
mesh_terms: D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000295:instrumentation; D020878:Device Removal / Q000009:adverse effects*; D015259:Dopamine Agents / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000601:surgery / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000601:surgery
chemical_list: D015259:Dopamine Agents
keywords: Parkinson's disease; deep brain stimulation; dopamine; infection; subthalamic nucleus