Abstract
Background: Deep brain stimulation (DBS) is a well-established treatment for a variety of movement disorders. Rechargeable cell technology was introduced to pulse generator more than 10 years ago and brought great benefits to patients. However, with the widespread use of rechargeable implanted pulse generators (r-IPGs), a new hardware complication, when charging the r-IPG has been difficult, was encountered.Objective: The aims of this study were to report five cases confronted with r-IPG charging difficulty postoperatively and to explore the predisposing factors and treatment strategies for this rare complication.Methods: We retrospectively reviewed our DBS patient database for those who were implanted with r-IPGs. From 2012, we identified a total of 1,226 patients, with five of them experiencing charging difficulties after surgery. Detailed patient profiles and clinical procedures were scrutinized and reviewed.Results: All the charging problems were resolved by reoperation. Cases 1 and 2 required their r-IPGs to be anchored to the muscle and fascia. Cases 3 and 4 had their r-IPGs inserted in the wrong orientation at the initial surgery, which was resolved by turning around the r-IPGs at the revision surgery. Case 5, in which we propose that the thick subcutaneous fat layer blocked the connection between the r-IPG and the recharger, required a second operation to reposition the r-IPG in a shallow layer underneath the skin. For all cases, the charging problems were resolved without reoccurrences to date.Conclusion: Our case series indicates a novel hardware complication of DBS surgery, which had been rarely reported before. In this preliminary study, we describe several underlying causes of this complication and treatment methods.
Highlights
Deep brain stimulation (DBS) has been shown to be a safe and effective treatment for a variety of movement disorders such as Parkinson’s disease (Zhang et al, 2020b) and dystonia (Krauss et al, 2021) and neurobehavioral disorders like Tourette syndrome (Xu et al, 2020)
A plain X-ray (Figure 1A) examination revealed that the rechargeable implanted pulse generators (r-implanted pulse generator (IPG)) was upside down inside the chest pocket
During the 18 months postoperative, she had lost more than 15 kg of weight and admitted intentional manipulation of her r-IPG
Summary
Deep brain stimulation (DBS) has been shown to be a safe and effective treatment for a variety of movement disorders such as Parkinson’s disease (Zhang et al, 2020b) and dystonia (Krauss et al, 2021) and neurobehavioral disorders like Tourette syndrome (Xu et al, 2020). The introduction of rechargeable implanted pulse generators (r-IPGs) in the 2000s has brought great benefits to DBS patients (Zhang et al, 2020a), including prolonging the life of the pulse generators and reducing the time of IPG replacement surgeries (Qiu et al, 2021), thereby alleviating the suffering of DBS patients and lowering the associated risks of potential infections (Thrane et al, 2014). Rechargeable cell technology was introduced to pulse generator more than 10 years ago and brought great benefits to patients. With the widespread use of rechargeable implanted pulse generators (r-IPGs), a new hardware complication, when charging the r-IPG has been difficult, was encountered
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