Objective: Deep Brain Stimulation (DBS) is a widely used neuromodulation therapy for managing motor complications in advanced Parkinson’s disease (PD). However, abrupt cessation of DBS, often due to internal pulse generator(IPG) depletion or infection, may lead to DBS withdrawal syndrome, a condition resembling Parkinsonism-Hyperpyrexia Syndrome(PHS)with a high risk of morbidity and mortality.

Background: DBS, particularly subthalamic nucleus (STN) stimulation, has been shown to significantly reduce levodopa equivalent daily dose(LEDD), leading to improved motor control and fewer medication-related complications. Despite technological advancements, DBS-related complications such as battery depletion and hardware infection can result in the sudden loss of neurostimulation, triggering severe clinical deterioration.DBS withdrawal syndrome can progress to life-threatening conditions.

Method: We report three cases of DBS withdrawal syndrome resulting from IPG depletion in two patients and IPG infection in one patient. All patients were evaluated based on clinical symptoms, laboratory findings, and response to DBS reimplantation.

Results: Case1:A 73-year-old woman with 13 years of PD, treated with bilateral STN-DBS for 7 years, presented with progressive rigidity, bradykinesia, dysphagia, and confusion over 10 days. Case2: A 31-year-old man with juvenile PD (PARK2 mutation)for 10 years, previously treated with STN-DBS, developed local swelling and infection at the IPG site, necessitating device removal. Within 5 days of DBS cessation, he experienced severe rigidity, tremor, and respiratory distress due to aspiration pneumonia.Case3: A 54-year-old man with 11 years of PD, treated with bilateral STN-DBS for 4 years, presented with tremor, gait disturbances, and feeding difficulties after missing routine follow-ups for 2 years.

Conclusion: DBS withdrawal syndrome is a critical and potentially fatal complication of abrupt neurostimulation cessation in PD patients. Timely recognition and urgent IPG replacement are essential to prevent severe motor and autonomic deterioration. Dopaminergic rescue therapy alone is often insufficient, emphasizing the need for prompt DBS reimplantation. Regular follow-ups, patient education on battery monitoring, and the use of rechargeable IPG systems may help reduce the risk of DBS withdrawal syndrome.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dbs-withdrawal-syndrome-in-advanced-parkinsons-disease-a-case-series/