A case-based review of troubleshooting deep brain stimulator issues in movement and neuropsychiatric disorders.

OBJECTIVE To review the spectrum of problems that can occur in the DBS patient and to suggest potential troubleshooting tips for identification and management of DBS related issues. BACKGROUND Deep brain stimulation (DBS) has become commonplace for the treatment of medication-refractory neurological disorders. There remains no consensus on the best practices for screening, surgical techniques, and post-operative care. There are few experienced DBS programmers and scarce resources available describing approaches for troubleshooting DBS problems. METHODS We present a case-based review that offers practical tips for the management and troubleshooting of difficult to manage DBS cases. We present 10 cases to demonstrate common issues encountered in DBS management. RESULTS There are many important difficulties that may be encountered with DBS devices, and practitioners should be aware of these potential problems, as well as rational management solutions. The following areas should be emphasized as potential causes of difficulties: a non-ideal initial DBS candidate, inadequate multidisciplinary team care, failure of perceived expectations, DBS procedural complication, hardware complication, suboptimal lead placement, programming, access to care, disease progression, and tolerance/habituation. CONCLUSION Neurologists seeing DBS patients should become familiar with issues involved in difficult to manage DBS cases. Many "DBS failures" are currently treatable by appropriate medicine, programming, and surgical approaches.

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