title: Sudden loss of the deep brain stimulation effect with high impedance without macroscopic fracture: a case report and review of the published literature.
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.
authors.affiliation: Department of Neurology, Ulsan University Hospital, Ulsan, South Korea.
authors.forename: Hui-Jun
authors.initials: HJ
authors.lastname: Yang
authors.affiliation: Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, South Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Yun
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea.
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Yong Hoon
authors.initials: YH
authors.lastname: Lim
authors.affiliation: Department of Neurology and Movement Disorder Center, Parkinson's Disease Study Group and Neuroscience Research Institute, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Han-Joon
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Sun Ha
authors.initials: SH
authors.lastname: Paek
authors.affiliation: Department of Neurology and Movement Disorder Center, Parkinson's Disease Study Group and Neuroscience Research Institute, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Beom S
authors.initials: BS
authors.lastname: Jeon
keywords: Parkinson’s disease; connector block; hardware complication; implantable neurostimulators