Denial of hardware-related skin erosion in patients with effective deep brain stimulation: a novel phenomenon

Introduction: Deep brain stimulation (DBS) is an established therapy that can significantly improve patients' quality of life in several disorders. Besides its benefits, hardware-related problems including erosion and wound infections are well known problems. In the present series, we describe a novel phenomenon manifesting as denial for hardware-related skin erosion in patients with movement disorders benefiting from DBS in various targets. Methods: Patients were collected from two large DBS cohorts over a period of 28 years. The skin erosion was identified upon the occasion of a routine follow-up with the patients apparently being unaware/not noticing its occurrence. Demographic, clinical and operative data were analyzed. Additionally, the hardware-related skin erosion and its time of diagnosis, as well as the consecutive treatment were registered. Results: Overall, five patients were identified with denial for hardware-related skin erosion. Three were men, two were women. The mean age at surgery was 66 years (range, 54 to 78). Three patients had dystonia, two patients had Parkinson’s disease. DBS targets were the globus pallidus internus, and various thalamic nuclei. All patients benefited markedly from chronic DBS (mean improvement of 76.7% according to the specific rating scales). The hardware-related skin erosion was diagnosed at a median follow-up of 18 months after DBS implantation (range, 5 to 264 months). Despite multiple surgical attempts at preservation, the neurostimulation system was ultimately explanted in three patients. Conclusion: Denial towards hardware-related skin erosion in DBS, most probably denial, is a rare but potentially serious complication during chronic DBS.