Recharging Difficulty With Pulse Generator After Deep Brain Stimulation: A Case Series of Five Patients

Background Deep brain stimulation (DBS) is an 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 benefit to patients. However, with the widespread of rechaegeable implanted pulse generator (r-IPG), a new hardware complication, when charging the r-IPG has been difficult was encountered. Objective The aim of this study is to report five cases who confronted with r-IPG charging difficulty post-operatively and explore predisposing factors and treating strategies of this rare complication. Methods We retrospectively reviewed our DBS patients database who were implanted with r-IPGs. Since 2012, we identified a total of 1226 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 1-2 required their r-IPGs to be anchored to the muscle and fascia. Cases 3-4 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, which we propose that the thick subcutaneous fat layer block the connection between the r-IPG and the recharger, required second operation to reposition the r-IPG in a shallow layer underneath the skin. For all cases, charging problems were resolved without reoccurrences to date. Conclusion Our case series indicate 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 treating methods.