Vol 55, No 4 (2021)
Review Article
Published online: 2021-05-31

open access

Page views 1697
Article views/downloads 1102
Get Citation

Connect on Social Media

Connect on Social Media

Battery for deep brain stimulation depletion in Parkinson’s Disease and dystonia patients — a systematic review

Filip Przytuła1, Jarosław Dulski12, Michał Sobstyl3, Jarosław Sławek12
Pubmed: 34056704
Neurol Neurochir Pol 2021;55(4):346-350.


Introduction. Deep brain stimulation (DBS) therapy for Parkinson’s Disease (PD) and dystonia is associated with the possibility of both minor and major complications. One possible side effect is the depletion of implantable pulse generator (IPG) battery and the associated sudden recurrence of PD or dystonia symptoms, which can be potentially life-threatening. Delayed or postponed outpatient visits due to COVID -19 may be a risk factor of battery end-of-life consequences.

Objective. To analyse the clinical outcomes in reported PD and dystonia patients treated with DBS, who, as a result of the sudden depletion of the neurostimulator battery, developed life-threatening symptoms.

Materials and methods. The databases of PubMed, Scopus, EMBASE and Google Scholar were searched using pre-established criteria.

Results. A total of 244 articles was found, of which 12 met the adopted criteria. Selected papers presented a total of 17 case reports of DBS-treated patients — 11 with PD, and six with dystonia — who had depleted IPG batteries and due to rapid worsening of PD/dystonia symptoms required urgent hospital admission. IPG battery replacement was the only effective treatment in the majority of cases.

Conclusions. IPG battery depletion can result in fatal outcomes. Sudden recurrence of PD or dystonia symptoms in patients treated by DBS can be potentially life-threatening, so scheduling the replacement of a discharged IPG battery should not be postponed. The COVID-19 pandemic should alert staff at emergency, neurology and movement disorders wards not to postpone the visits of patients with an implanted DBS system.

Article available in PDF format

View PDF Download PDF file


  1. Hu W, Stead M, Klassen BT. Surgery for movement disorders. J Neurosurg Sci. 2011; 55(4): 305–317.
  2. Krack P, Volkmann J, Tinkhauser G, et al. Deep brain stimulation in movement disorders: from experimental surgery to evidence-based therapy. Mov Disord. 2019; 34(12): 1795–1810.
  3. Dulski J, Schinwelski M, Konkel A, et al. The impact of subthalamic deep brain stimulation on polysomnographic sleep pattern in patients with Parkinson's disease - Preliminary report. Neurol Neurochir Pol. 2018; 52(4): 514–518.
  4. Sobstyl M, Stapińska-Syniec A, Giziński J, et al. Deep brain stimulation hardware-related complications and their management: A single-center retrospective analysis of 65 patients with various dystonic conditions. J Neurol Sci. 2019; 407: 116513.
  5. Sobstyl M, Stapińska-Syniec A, Rylski M. Deep brain stimulation procedure complicated by spontaneously resolved pneumothorax in a patient with cervical dystonia. Neurol Neurochir Pol. 2021; 55(1): 110–112.
  6. Holla VV, Neeraja K, Surisetti BK, et al. Deep brain stimulation battery exhaustion during the COVID-19 pandemic: crisis within a crisis. J Mov Disord. 2020; 13(3): 218–222.
  7. Miocinovic S, Ostrem JL, Okun MS, et al. Recommendations for deep brain stimulation device management during a pandemic. J Parkinsons Dis. 2020; 10(3): 903–910.
  8. Chou KL, Siderowf AD, Jaggi JL, et al. Unilateral battery depletion in Parkinson's disease patients treated with bilateral subthalamic nucleus deep brain stimulation may require urgent surgical replacement. Stereotact Funct Neurosurg. 2004; 82(4): 153–155.
  9. Neuneier J, Barbe MT, Dohmen C, et al. Malignant deep brain stimulation-withdrawal syndrome in a patient with Parkinson's disease. Mov Disord. 2013; 28(12): 1640–1641.
  10. Artusi CA, Merola A, Espay AJ, et al. Parkinsonism-hyperpyrexia syndrome and deep brain stimulation. J Neurol. 2015; 262(12): 2780–2782.
  11. Rajan R, Krishnan S, Kesavapisharady KK, et al. Malignant subthalamic nucleus-deep brain stimulation withdrawal syndrome in Parkinson's disease. Mov Disord Clin Pract. 2016; 3(3): 288–291.
  12. Liu CJJ, Crnkovic A, Dalfino J, et al. Whether to proceed with deep brain stimulator battery change in a patient with signs of potential sepsis and Parkinson hyperpyrexia syndrome: a case report. A A Case Rep. 2017; 8(8): 187–191.
  13. Azar J, Elinav H, Safadi R, et al. Malignant deep brain stimulator withdrawal syndrome. BMJ Case Rep. 2019; 12(5).
  14. Kamel WA, Al-Hashel JY, Damier P, et al. Decreased level of consciousness due to a depleted deep brain stimulator battery: Paving the way to wake up the brain? Rev Neurol (Paris). 2019; 175(4): 274–275.
  15. Li H, Zhang C, Pan Y, et al. Status dystonicus in pantothenate kinase-associated neurodegeneration due to internal pulse generator depletion: Case study and literature review. J Neurol Sci. 2019; 400: 44–46.
  16. Rohani M, Munhoz RP, Shahidi G, et al. Fatal status dystonicus in tardive dystonia due to depletion of deep brain stimulation's pulse generator. Brain Stimul. 2017; 10(1): 160–161.
  17. Sobstyl M, Ząbek M, Kmieć T, et al. Status dystonicus due to internal pulse generator depletion in a patient with primary generalized dystonia. Mov Disord. 2014; 29(2): 188–189.
  18. Yianni J, Nandi D, Ch M, et al. Failure of chronic pallidal stimulation in dystonic patients is a medical emergency. Neuromodulation. 2004; 7(1): 9–12.
  19. Fasano A, Antonini A, Katzenschlager R, et al. Management of advanced therapies in Parkinson's disease patients in times of humanitarian crisis: the COVID-19 experience. Mov Disord Clin Pract. 2020; 7(4): 361–372.
  20. Newman EJ, Grosset DG, Kennedy PGE. The parkinsonism-hyperpyrexia syndrome. Neurocrit Care. 2009; 10(1): 136–140.
  21. Factor SA. Fatal Parkinsonism-hyperpyrexia syndrome in a Parkinson's disease patient while actively treated with deep brain stimulation. Mov Disord. 2007; 22(1): 148–149.
  22. Newman EJ, Grosset DG, Kennedy PGE. The parkinsonism-hyperpyrexia syndrome. Neurocrit Care. 2009; 10(1): 136–140.
  23. Sobstyl MR, Sławek JW, Ząbek M. The neurosurgical treatment of patients in dystonic state - overview of the literature. Neurol Neurochir Pol. 2014; 48(1): 63–70.
  24. Mitchell KT, Volz M, Lee A, et al. Patient experience with rechargeable implantable pulse generator deep brain stimulation for movement disorders. Stereotact Funct Neurosurg. 2019; 97(2): 113–119.
  25. Bin-Mahfoodh M, Hamani C, Sime E, et al. Longevity of batteries in internal pulse generators used for deep brain stimulation. Stereotact Funct Neurosurg. 2003; 80(1-4): 56–60.