Objective: In this series, we report two rare cases of selective unawareness to hardware-related complications in deep brain stimulation (DBS).

Background: DBS has shown good long-term efficacy in movement disorders, which is known to have a significant positive impact on the quality of life of patients. Besides this benefit, hardware complications are a reality and a major concern physicians can face.

Method: From one high-volume center performing DBS for movement disorders, cases of hardware-related complications were reviewed, and cases in which patients ignored completely the complication were selected.

Results: Two patients were identified. One case of a 53-year-old patient, who underwent bilateral DBS surgery on the ventralis intermedius nucleus for dystonic head tremor with a significant improvement of both tremor and his quality of life, but who completely ignored a precoronal wound dehiscence with pus. The second case includes a 72-year-old patient, a former physician, with segmental dystonia, who, after 22 years of bilateral DBS surgery on the globus pallidus internus, appeared in the emergency department with complete exposure to the electrodes, and ignored the fact when confronted with it.

Conclusion: These patients exhibited anosognosia since they completely ignored their hardware-related complications, but were fully aware of other features. This may be derived from a higher focus on the positive effect of the stimulation and complete unawareness of any complication, or from an underlying fear of the possible consequences of a hardware complication, including removal of their life-changing therapy. Physicians should be aware of this phenomenon in patients undergoing DBS, underlying thus the importance of regular follow-up visits, especially of patients reporting a significant improvement with DBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/anosognosia-for-hardware-related-complications-in-deep-brain-stimulation/