Malignant deep brain stimulation withdrawal syndrome following elective implantable pulse generator replacement. A case report

Malignant deep brain stimulation (DBS) withdrawal syndrome constitutes a rare neurological emergency among advanced Parkinson's disease (PD) patients treated with the subthalamic nucleus (STN) Deep Brain Stimulation. Its clinical course mimics Neuroleptic Malignant Syndrome and when left untreated might lead to death. We present a case of a 61 year old woman treated with STN DBS because of PD, who underwent under local anesthesia implantable pulse generator (IPG) replacement. The IPG stopped functioning several days before the replacement. Due to increased motor symptoms the patient was unable to intake medications several days prior to surgical intervention. Within immediate post-operative period she developed malignant DBS withdrawal syndrome. The successful treatment consisted of supportive care, dopaminergic medication and immediate restoration of the IPG.