Damage to the entire deep brain stimulation system after the standard replacement of an implantable pulse generator, probably due to self-injurious behavior in a patient with advanced Parkinson’s disease

Purpose
Deep brain stimulation for Parkinson’s disease (PD) is an established treatment modality for disabling Parkinsonian motor symptoms in off medication condition and levodopa-induced dyskinesia in on medication condition.

Case description
We report on the case of a 70-year-old woman with a 22-year history of PD diagnosis who had been treated with dopaminergic medication over this period. At age of 59, she underwent a staged bilateral implantation of deep brain stimulation (DBS) leads targeting the subthalamic nucleus (STN) with good control of Parkinsonian motor symptoms and the reduction of her daily levodopa dose by 50% after bilateral STN DBS. The patient damaged her DBS system after the standard replacement of a depleted left implantable pulse generator, which resulted in the removal of the entire deep brain stimulation system on the left side.

Comment
To our knowledge, this is the first report of probably self-injurious behavior in the context of a deep brain stimulation system related to the longstanding dopaminergic treatment of PD. Patients in advanced stages of PD require special care for the follow- up maintenance of sophisticated treatment modalities like DBS.