Uncoupling of dopaminergic and subthalamic stimulation: Life‐threatening DBS withdrawal syndrome

BACKGROUND: Deep brain stimulation (DBS) in therapy for advanced Parkinson's disease (PD) is an accepted treatment. Infections of the system and other complications occasionally result in hardware removal and subsequent medical treatment alone for months. METHODS: We have analyzed the clinical course of 15 patients requiring removal of at least parts of the DBS system, resulting in a cessation of stimulation. RESULTS: Most had an uncomplicated return to medical treatment. Three had an unfavorable course during withdrawal, including two deaths. These patients had suffered from PD for more than 18 y and had had DBS for more than 8 y. CONCLUSIONS: We conclude that DBS withdrawal can be life-threatening, because the whole range of dopaminergic and nondopaminergic medical treatments may be ineffective at this stage. The lack of response to medical treatment might be attributable to advanced disease and long-term changes of the basal ganglia loop in PD.