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

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 Hospi...

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Autores principales:	Yang HJ, Yun JY, Kim YE, Lim YH, Kim HJ, Paek SH, Jeon BS
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2015
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/14598da9ad4f4f1b944651eadf0d3215
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spelling	oai:doaj.org-article:14598da9ad4f4f1b944651eadf0d32152021-12-02T07:15:58ZSudden loss of the deep brain stimulation effect with high impedance without macroscopic fracture: a case report and review of the published literature1178-2021https://doaj.org/article/14598da9ad4f4f1b944651eadf0d32152015-07-01T00:00:00Zhttp://www.dovepress.com/sudden-loss-of-the-deep-brain-stimulation-effect-with-high-impedance-w-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Hui-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 diseaseYang HJYun JYKim YELim YHKim HJPaek SHJeon BSDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2015, Iss default, Pp 1799-1803 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Yang HJ Yun JY Kim YE Lim YH Kim HJ Paek SH Jeon BS Sudden loss of the deep brain stimulation effect with high impedance without macroscopic fracture: a case report and review of the published literature
description	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
format	article
author	Yang HJ Yun JY Kim YE Lim YH Kim HJ Paek SH Jeon BS
author_facet	Yang HJ Yun JY Kim YE Lim YH Kim HJ Paek SH Jeon BS
author_sort	Yang HJ
title	Sudden loss of the deep brain stimulation effect with high impedance without macroscopic fracture: a case report and review of the published literature
title_short	Sudden loss of the deep brain stimulation effect with high impedance without macroscopic fracture: a case report and review of the published literature
title_full	Sudden loss of the deep brain stimulation effect with high impedance without macroscopic fracture: a case report and review of the published literature
title_fullStr	Sudden loss of the deep brain stimulation effect with high impedance without macroscopic fracture: a case report and review of the published literature
title_full_unstemmed	Sudden loss of the deep brain stimulation effect with high impedance without macroscopic fracture: a case report and review of the published literature
title_sort	sudden loss of the deep brain stimulation effect with high impedance without macroscopic fracture: a case report and review of the published literature
publisher	Dove Medical Press
publishDate	2015
url	https://doaj.org/article/14598da9ad4f4f1b944651eadf0d3215
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Sudden loss of the deep brain stimulation effect with high impedance without macroscopic fracture: a case report and review of the published literature

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