Question 1

How do I tell the difference in sudden symptom return from other causes?

Accepted Answer

A sudden return of symptoms can come from several causes that overlap in how they feel, so the goal is not to “self-diagnose,” it is to sort the pattern into a small number of plausible buckets that your DBS team can test.¹–³ The most useful first distinction is time course: disease progression usually appears as a gradual change over weeks to months, while medication timing effects and stimulation-state changes can look abrupt or fluctuate within a day.⁴,⁵

Another practical distinction is responsiveness: symptoms that predictably improve after a medication dose, a rest period, or a sleep recovery often point toward physiology and dosing dynamics, while symptoms that match a device event, such as therapy being off or a sudden change in battery status, raise suspicion for a therapy interruption.¹–³ Many people also have “context-sensitive” changes, where stress, illness, dehydration, or sleep loss makes symptoms break through, even when DBS and medications are unchanged, because motor and non-motor symptoms are influenced by broader brain and body state.⁴,⁵

A structured history makes this more testable in clinic, because programming adjustments and device checks are built around reproducible symptom-response relationships.¹–³ If the symptom change has a clear start time, note the exact clock time and what was happening in the hours before, including medication doses, missed doses, new medicines, sleep duration, and any new illness symptoms.¹–³ If you can safely check whether stimulation is on using your patient controller, record what it shows without changing settings unless your clinician has specifically instructed you to do so.¹–³

If symptoms improve or worsen with specific postures, head and neck movement, or arm elevation, clinicians sometimes consider mechanical factors such as extension strain or intermittent connection, although these patterns are not specific and still require device interrogation.³,¹⁴

The value of time course and medication-response patterning is well-established in movement disorders care and DBS troubleshooting, but no single pattern is definitive without clinician interrogation of device status and programming history.¹–⁵

Glossary:

DBS: Deep brain stimulation, an implanted system that delivers programmed electrical stimulation to specific brain targets to reduce symptoms.⁴,⁵

Time course: The shape of change over time, such as minutes, hours, days, or months, used to narrow likely causes.¹–³

Therapy interruption: A situation where stimulation is unexpectedly off or not being delivered as intended due to settings, battery, or hardware issues.¹–³

Device interrogation: Clinician use of a programmer to read device status, including battery, impedances, and programmed parameters.¹–³

Question 2

What are red flags that suggest a hardware or therapy problem rather than natural variability?

Accepted Answer

Red flags are patterns that are uncommon for normal symptom variability and that push clinicians to check device status urgently rather than assuming biology alone.¹–³ The most important red flag category is abrupt loss of previously reliable benefit, especially if it occurs “overnight” or within hours without an obvious medication or illness explanation.¹,³,¹⁵

Another category is a sudden appearance of new stimulation-like side effects at the same settings, which can happen if current spread changes because of programming changes, contact changes, or hardware integrity issues that alter the electrical field.¹–³ Hardware problems are not the most common cause of symptom fluctuation, but they are clinically important because they can require rapid correction or surgical evaluation.¹⁵,¹⁶

Clinicians often take the following patterns seriously because they map to known failure modes described in DBS troubleshooting literature.¹,¹⁵,¹⁶ New “device alerts,” an unexpected therapy-off state, or a controller message that the device cannot be found can indicate battery depletion, pairing problems, or system malfunction and should be documented exactly as displayed.¹–³ A sudden large change in measured impedance, especially very high values suggesting an open circuit or very low values suggesting a short circuit, can indicate connector problems, lead or extension issues, or internal IPG faults, and it usually prompts a stepwise hardware evaluation.¹⁴,¹⁷–¹⁹

Worsening symptoms plus faster-than-expected battery drain can be seen with certain short-circuit patterns because lower impedance increases current draw, although this is device- and setting-dependent and needs programmer confirmation.¹⁸

An abrupt loss of benefit and major impedance shifts are well-described in DBS troubleshooting case series and reviews, but the exact threshold values and responses can vary by manufacturer and by constant-current versus constant-voltage systems.¹⁴,¹⁵,¹⁷–¹⁹

Glossary:

Red flag: A symptom or device pattern that increases suspicion for therapy interruption or hardware malfunction rather than routine variability.¹–³

Open circuit: An electrical discontinuity that can present as abnormally high impedance and reduced or absent stimulation delivery.¹⁴,¹⁷,¹⁹

Short circuit: An unintended low-resistance pathway that can present as abnormally low impedance and increased battery use or altered stimulation effects.¹⁴,¹⁸,¹⁹

IPG: Implantable pulse generator, the implanted battery and electronics that generate stimulation pulses.¹–³

Question 3

What does “stimulation-induced side effect” mean, and what are common examples?

Accepted Answer

A stimulation-induced side effect is a symptom caused by the stimulation itself rather than by the underlying condition, medication, or a separate illness.¹–³ This matters because stimulation side effects are often adjustable, meaning they may improve with parameter changes, contact selection changes, or directional steering when available, without changing the underlying disease course.¹–³ 
The mechanism is typically spread of the electrical field beyond the intended target, activating nearby fiber pathways or neighboring structures that control speech, balance, sensation, eye movements, or mood-related circuits.¹–³ The same person can have both disease symptoms and stimulation side effects at the same time, which is why careful timing and “what changed first” documentation is so important.¹–³

Common examples depend on the brain target and the condition being treated, but several patterns are repeatedly described in programming literature.¹–³

Paresthesias, meaning tingling or electric sensations, can occur when sensory pathways are stimulated, and they often appear quickly when stimulation is increased beyond a threshold.¹–³

Muscle pulling or sustained contractions can occur when current spreads toward motor pathways such as the internal capsule, and these effects can be side-specific and posture-sensitive depending on the contact configuration.¹–³

Dysarthria, meaning slurred or effortful speech, can be stimulation-related in some patients, particularly with certain targets and settings, and clinicians may respond by adjusting amplitude, pulse width, frequency, or contact selection to widen the therapeutic window.²⁰,²¹

The existence of stimulation-induced side effects and their relationship to current spread is well-established, but exact side-effect profiles vary by target, lead location, and device capabilities such as directional stimulation.¹–³

Glossary:

Stimulation-induced side effect: A symptom produced by DBS stimulation parameters or field spread rather than by the underlying disorder.¹–³

Electrical field spread: Extension of stimulation effects into adjacent tissue or fibers beyond the intended target zone.¹–³
Therapeutic window: The range between the stimulation level that improves symptoms and the level that produces unacceptable side effects.¹–³
Directional stimulation: A lead technology that can steer current to shape the activated region and sometimes reduce side effects.²,²²

Question 4

Which side effects are most associated with stimulation spread to nearby pathways?

Accepted Answer

This question matters because many “new symptoms” after DBS are actually predictable effects of stimulating neighboring circuits, and that can guide more precise troubleshooting.¹–³ Spread to motor pathways can produce involuntary muscle pulling, facial or limb contractions, or a sense of tightness, and clinicians often consider internal capsule involvement when these effects appear at lower-than-expected amplitudes.¹–³

Spread to sensory pathways can produce tingling, numbness-like sensations, or unusual sensory perceptions that are time-locked to stimulation changes.¹–³ Speech and balance changes can be multifactorial, because DBS can improve some motor symptoms while also affecting articulation and gait in some individuals depending on target, lead placement, and settings.²⁰,²¹

Programming reviews and expert consensus documents describe certain associations that clinicians use as working hypotheses during adjustment.¹–³

Speech changes such as reduced clarity can be stimulation-related and may improve with parameter changes or contact adjustments, though they can also reflect disease progression or medication effects, which is why clinicians test changes in a controlled way.²⁰,²¹

Balance and gait worsening can also be stimulation-related in some patients, and reprogramming can sometimes improve it, but not all gait and balance problems respond to stimulation changes, especially in later disease stages.²⁰,²¹

Mood and behavioral changes after DBS are complex, because they may relate to stimulation of limbic-associated circuits, medication changes after surgery, or the underlying condition itself, so most teams approach them with joint neurologic and psychiatric assessment rather than assuming a single cause.¹–⁵,⁸

Associations between current spread and paresthesia or muscle pulling are relatively direct and widely reported, while speech, balance, and mood effects have more mixed causality and often require iterative testing.¹–³,²⁰,²¹

Glossary:
Internal capsule: A major white-matter pathway near common DBS targets, stimulation of which can cause muscle contractions or pulling sensations.¹–³

Paresthesia: Tingling or “pins and needles” sensations that can occur when sensory pathways are stimulated.¹–³

Gait: The pattern of walking, including stride length, speed, and stability, which can change with stimulation or disease.²⁰,²¹
Limbic circuits: Brain networks involved in mood, motivation, and emotional regulation that can be affected indirectly by DBS settings or medication shifts.⁴,⁸

Question 5

What practical steps help describe side effects accurately, timing, body side, situation triggers, dose timing?

Accepted Answer

Clear side-effect description is a clinical tool, because it allows programming changes to be tested against a stable “before and after” record instead of memory alone.¹–³ This matters even more when symptoms fluctuate, because clinicians are trying to identify reproducible relationships between parameters and effects, which is the basis of rational programming.¹–³

The most helpful descriptions are specific, time-stamped, and anchored to observable changes, such as “speech became slurred within 10 minutes of turning therapy on” rather than “speech felt off.”¹–³ The goal is not perfect language, it is consistent data that can be compared across visits.¹–³

A practical documentation approach focuses on four domains that clinicians routinely ask about in DBS clinics.¹–³

The first domain is timing: write down when the side effect starts, how long it lasts, whether it fades with time at a constant setting, and whether it appears immediately after a dose change or only after a certain activity.¹–³

The second domain is laterality and body distribution: note which side of the body is affected, which muscle groups or functions are involved, and whether it is localized or generalized, because DBS effects are often side-specific depending on lead location and contact selection.¹–³

The third domain is context: record triggers such as talking, chewing, standing, turning the head, exercise, or stress, because context can reveal interactions between stimulation and functional demands.¹–³

The fourth domain is medication timing: record exact dosing times and any missed or delayed doses, because motor fluctuations and dyskinesias can reflect medication “on/off” dynamics even after DBS.⁴,²³

The clinical utility of structured symptom diaries and time-locked descriptions is widely accepted in DBS programming practice, but the best format varies by clinic and by patient capability and access.¹–³

Glossary:

Laterality: The side of the body, left or right, where a symptom occurs, which is often informative in DBS.¹–³

Trigger: A context or activity that reliably brings on or worsens a symptom, used to test stimulation effects.¹–³

Motor fluctuation: Variation in motor symptoms over the day, often related to medication kinetics and disease stage.⁴,²³

Dyskinesia: Involuntary movements often related to dopaminergic medication levels and sometimes influenced by DBS and medication adjustments.⁴,²³

Question 6

What are “on/off” phenomena after DBS, and why can they still happen for some people?

Accepted Answer

“On/off” phenomena describe periods when symptoms are better (“on”) and periods when symptoms return (“off”), often linked to medication timing, even in people who also have DBS.⁴,⁵

This matters because DBS can reduce motor fluctuations for many patients, but it does not always eliminate them, and some fluctuation patterns persist due to medication pharmacokinetics, disease progression, and the fact that DBS targets specific symptom circuits more strongly than others.⁴,⁵,²⁰

After DBS, your medical team often adjust your medications, and changes in dose timing or total daily dose can reshape the on/off pattern in ways that may look like “DBS stopped working” when it is actually a new medication-stimulation balance.¹–⁵ Some people also experience complex patterns such as off-period dystonia or dyskinesia that can occur at low medication levels or during transitions, and these can persist even when core tremor or rigidity responds well to DBS.²³,²⁴

A useful way to think about on/off after DBS is to separate stimulation-state stability from dopamine-state variability.¹–⁵ If stimulation is stable and correctly delivered, the remaining variability is often driven by medication absorption, meal effects, timing, and disease-related changes in dopamine buffering capacity, which is why clinicians may still recommend dose timing adjustments or extended-release strategies in some cases.⁴,²³

Some dyskinesias can change form after DBS and medication adjustments, and clinicians may need to differentiate peak-dose dyskinesia, diphasic dyskinesia, and off-period dystonia because they respond differently to medication and programming changes.²³,²⁴ When fluctuation patterns are unclear, some centers use standardized rating scales and timed assessments in defined medication and stimulation states to make the pattern less subjective.¹–³

The persistence of on/off phenomena after DBS is well-described in Parkinson disease literature, but the relative contribution of stimulation versus medication varies widely across individuals and over time.⁴,⁵,²⁰,²³

Glossary:

On/off phenomena: Fluctuations between better and worse symptom states, often linked to medication timing and disease stage.⁴,²³

Off-period dystonia: Sustained muscle contractions occurring during low medication effect periods, sometimes seen in Parkinson disease.²³

Diphasic dyskinesia: Dyskinesia occurring during transitions into or out of medication “on” states rather than at peak dose.²³

Timed assessment: A structured clinic evaluation at specific times relative to medication dosing and stimulation state to clarify response patterns.¹–³

Question 7

What does it mean when programming “isn’t enough,” and what are typical next options?

Accepted Answer

When programming “isn’t enough,” it usually means that repeated, systematic adjustments haven't produced a stable balance of symptom control and side-effect tolerability that meets the person’s functional needs.¹–³

“Not enough” can reflect different root causes, including lead location relative to the intended target, disease features that are less DBS-responsive, medication interactions, or hardware problems that mimic poor programming response.¹–⁵,¹⁵ Clinicians often treat this as a diagnostic problem, not a failure of the patient, because many cases that look like “DBS failure” improve after methodical reassessment.¹⁵ The next steps are typically staged, starting with verification of therapy delivery and optimization attempts, and moving toward imaging review and surgical considerations only when the evidence supports it.¹,¹⁵,¹⁶
In a large case study of referred DBS “failures,” common correctable issues included suboptimal programming, medication mismatches, lead location issues, and misunderstood expectations about which symptoms DBS can improve.¹⁵

A typical way to correct this includes a reprogramming session with a careful mapping of contacts and parameter-response, a medication review to restore an effective balance, and a device integrity check including impedances and battery performance.¹–³,¹⁴ If improvement remains limited, clinicians may review postoperative imaging to assess lead location relative to target anatomy, because even small differences can change the therapeutic window.¹–³

When a potentially correctable structural issue is identified, surgical options such as lead revision or repositioning may be discussed, but this is usually after careful documentation that non-surgical optimization has been exhausted.¹⁵,¹⁶

Evidence supports systematic re-evaluation and the possibility of improvement in a meaningful subset of “suboptimal” DBS cases, but prediction of who will benefit from further intervention remains imperfect.¹⁵,¹⁶

Glossary:

Suboptimal response: Benefit that is less than expected or not functionally sufficient despite reasonable attempts at programming and medication adjustment.¹⁵,¹⁶

Contact mapping: Testing different electrode contacts and settings to identify the best symptom benefit and side-effect thresholds.¹–³

Postoperative imaging review: Using CT or MRI, when allowed by labeling, to confirm lead position relative to brain targets and anatomy.¹–³,⁶–¹⁰

Therapeutic window: The difference between benefit threshold and side-effect threshold for a given contact and setting.¹–³

Question 8

When might a lead revision, repositioning, or additional lead be discussed, and what is the reasoning?

Accepted Answer

Lead revision discussions usually start when clinicians have evidence that the current lead position or hardware integrity is limiting benefit in a way programming cannot overcome.¹⁵,¹⁶ This matters because DBS leads are fixed in the brain, and programming can shape stimulation, but it cannot fully compensate for a lead that is too far from the optimal target zone or one that is associated with repeated hardware failures.¹–³,¹⁵

The reasoning is typically framed around anatomy and physiology: the goal is to place stimulation where it affects the intended circuit while minimizing activation of nearby pathways that cause side effects.¹–³ Lead revision is not a routine step, and it is usually considered after systematic troubleshooting because revision carries surgical risks similar to the original implantation and requires a clear justification.¹⁶,²⁵

In DBS failure management series, revision considerations often include confirmed lead misplacement, lead migration, or a lead location that produces a narrow therapeutic window across multiple contacts.¹⁵,¹⁶ Hardware complication literature also describes scenarios where lead or extension fractures, connector issues, or recurrent erosions require surgical correction.¹⁶,²⁵ When an additional lead is discussed, it may be in the context of expanding symptom coverage or targeting additional circuits, but the appropriateness depends on diagnosis, target, and region-specific authorization for that indication.⁴,⁶,¹⁰

In the United States, some DBS uses are tied to FDA approvals for specific indications and targets, while other countries may use different regulatory pathways, such as European Union conformity assessment leading to CE marking, UK requirements managed by MHRA with UKCA marking, Health Canada device licensing, or Australia’s TGA inclusion in the ARTG, and those pathways influence labeling language and indication scope.⁶,¹¹–¹³

The logic for revision based on lead location, narrow therapeutic window, or hardware failure is widely recognized, but evidence on outcomes varies by indication, target, and the specific reason for revision.¹⁵,¹⁶,²⁵

Glossary:

Lead revision: Surgical replacement or repositioning of a DBS lead to address suboptimal placement or hardware failure.¹⁵,¹⁶

Lead migration: Movement of a lead from its intended position over time, which can change stimulation effects.¹⁶

Indication: The condition and intended use described in official device labeling, which can differ by region and by target.⁶,¹¹–¹³

Labeling: Manufacturer and regulator-recognized documents describing approved use and safety conditions, including MRI conditions and contraindications.⁶–¹⁰

Question 9

What is the microlesion effect, and how can early improvement fade after surgery?

Accepted Answer

The microlesion effect, also called an insertional effect, is a temporary clinical improvement that can occur after electrode implantation even before stimulation is turned on.²⁶,²⁷

This matters because early post-operative improvement can be real but transient, and it can complicate expectations about what stimulation will provide once healing stabilizes.²⁶,²⁷ The current understanding is that electrode insertion creates local tissue responses, including micro-injury and inflammatory changes that can temporarily alter neural activity in the target region and connected networks.²⁶,²⁷ In some studies, the degree of early improvement has correlated with later DBS response, but this is not reliable enough to use as a stand-alone predictor for individual outcomes.²⁶

Early improvement can fade as swelling resolves, tissue responses evolve, and the brain adapts to the presence of the electrode.²⁶,²⁷ This is one reason many centers stage programming over time rather than making large early assumptions about “best settings,” because the therapeutic window can shift during the first weeks to months.¹–³ The fade does not mean DBS stopped working, it often means the temporary insertional benefit ended and now the long-term benefit depends on active stimulation plus ongoing medication and rehabilitation strategy.¹–⁵

If someone is tracking symptoms, a useful approach is to label the timeline as “post-op healing phase” versus “stable programming phase,” because comparing those phases directly can be misleading.¹–³

Insertional effects are well-documented, but the biological mechanisms and the degree to which early effects predict long-term outcomes remain areas of active research.²⁶,²⁷

Glossary:

Microlesion effect: Temporary symptom improvement after DBS electrode implantation, occurring before stimulation is active.²⁶,²⁷

Insertional effect: A broader term emphasizing that electrode insertion itself can change brain activity and symptoms transiently.²⁷

Healing phase: The early post-operative period when tissue responses and symptom patterns may fluctuate independent of final programming.¹–³

Neuroplastic change: Longer-term adaptation in neural circuits that can alter symptom expression and therapy response over time.²⁷

Question 10

Why can the same settings feel different months later?

Accepted Answer

If the same settings feel different over time, it often reflects the fact that DBS is delivered into a living system that changes, even when the device output is stable.¹–⁵ This matters because people sometimes interpret a change in feeling as proof the device changed, when the more common explanation is a shift in tissue properties, medication context, or symptom biology.¹–³

Tissue around the lead can undergo changes in impedance and electrode-tissue interface characteristics over time, which can subtly affect how stimulation distributes, particularly in constant-voltage systems.¹⁴,¹⁷ At the same time, clinicians often adjust medications after DBS, and those changes can unmask or reshape symptoms that were previously controlled by a different medication-stimulation balance.⁴,⁵

Longer-term, disease progression can introduce symptoms that are less responsive to DBS, such as certain gait, balance, or cognitive features in some disorders, which can make overall function feel worse even if DBS is still doing what it was originally optimized to do.⁴,⁵,²⁰ The brain also adapts, and while the mechanisms are complex, it is clinically recognized that parameter needs can change over years, which is why periodic “tune-ups” are a normal part of long-term DBS care.¹–³ If a person notices gradual change, clinicians often reassess by re-testing thresholds, reviewing lead contacts, and comparing current symptom targets to original therapy goals.¹–³

Time-dependent shifts in impedance and the electrode-tissue interface are well-described, while the contribution of neural adaptation is harder to quantify and often inferred from clinical patterns.¹–⁵,¹⁴,¹⁷

Glossary:

Electrode-tissue interface: The physical and electrical boundary where the DBS contact meets surrounding brain tissue, which can change over time.¹⁴,¹⁷

Constant-voltage stimulation: A device mode where voltage is set and current varies with impedance, potentially changing delivered current if impedance changes.¹⁴,¹⁷

Constant-current stimulation: A device mode where current is set and voltage adjusts to maintain that current, potentially stabilizing delivered current across impedance changes.¹⁴,¹⁷

Disease progression: Gradual change in the underlying condition that can add symptoms or reduce responsiveness of certain symptoms to DBS.⁴,⁵

Question 11

What is the step-by-step troubleshooting checklist for symptom flare, controller check, therapy on, battery, recent changes, triggers, and documentation?

Accepted Answer

A stepwise checklist is useful because it prevents missing simple causes, such as therapy being off or a recent change in medication timing, before assuming a complex hardware problem.¹–³ This matters in real life because symptom flares can be stressful, and stress itself can worsen symptoms, which makes unstructured troubleshooting less reliable.⁴,⁵

A good checklist also produces a concise record your clinician can act on, rather than a general description that is hard to interpret.¹–³ The safest approach is to check information and document it, while avoiding unsupervised changes to settings unless your DBS team has already given specific instructions for patient-adjustable ranges.¹–³

A methodical sequence usually starts with verification of therapy status and ends with a time-stamped symptom and trigger record suitable for clinician review.¹–³
 • Confirm what the controller shows about therapy state, such as “on,” “off,” or a mode like MRI mode if your system uses one.⁶–¹⁰ Record the exact wording on the screen and the time you checked, because screen language differs across manufacturers and regions.⁶–¹⁰ If the controller indicates therapy is off unexpectedly, follow your clinic’s instructions, and document what happened rather than repeatedly toggling settings, because repeated changes can complicate later troubleshooting.¹–³
 • Check battery and charging status in a way that matches your system type, because rechargeable and non-rechargeable systems present problems differently.¹–³ If your system is rechargeable, document last successful charge time, typical charging interval, and any unusual charging behavior such as resets, alerts, or sensations during charging that differ from prior sessions.²⁸,²⁹ If your system is non-rechargeable, document any low-battery warnings and the timeline since the last battery check or replacement, because depleted batteries can cause therapy interruption.¹–³
 • Identify recent changes that could explain the flare without implying a device failure, including medication dose timing, missed doses, new drugs, sleep loss, acute illness symptoms, or major stress events.⁴,⁵ Write down exact medication times and any deviations from routine, because on/off phenomena and dyskinesia patterns are highly time-dependent.⁴,²³ If the flare follows a clinic visit, a programming change, or a medication change, record the date, because short-term adaptation after changes is common and often expected.¹–³
 • Document triggers and the symptom’s “signature,” including body side, specific functions affected, and whether it is constant or fluctuating.¹–³ Note whether symptoms change with posture, walking, speaking, or head and neck movement, because while these patterns are not diagnostic, they can help clinicians decide whether to consider intermittent connections or contact-specific side effects.¹–³,¹⁶ If you have the ability to safely repeat a simple standardized task, such as a short walk or a timed hand movement, record the result consistently so your clinician can compare across days.¹–³
 • If any red flags occur, such as abrupt loss of benefit with device alerts, inability to communicate with the device, or a concerning injury event, contact the appropriate clinician or emergency service rather than extending self-troubleshooting.¹⁵,¹⁶ In parallel, preserve information that can be lost, such as screenshots of controller messages or exact alert codes, because clinicians may not be able to reproduce them later.¹–³ This is especially important after charging-related resets or device behaviors described in manufacturer advisories and regulator communications.²⁸,²⁹

Structured troubleshooting and documentation are strongly supported by DBS programming practice, but exact steps vary by manufacturer interface and by clinic policy.¹–³,²⁸,²⁹

Glossary:

Patient-adjustable range: The limited set of changes a patient may be allowed to make on a controller, depending on clinician configuration.¹–³

MRI mode: A device state used by some systems to meet MRI safety conditions, often requiring activation before scanning and deactivation after.⁶–¹⁰

Controller alert code: A device-specific message that can indicate battery status, communication issues, or system faults.¹–³

Standardized task: A repeatable activity used for self-tracking, chosen for consistency rather than for intensity.¹–³

Question 12

What does it mean if impedance suddenly changes, and what should be done next?

Accepted Answer

Impedance is a measure of resistance to electrical current flow in the stimulation circuit, and it is one of the main objective signals clinicians use to assess hardware integrity and the electrode-tissue interface.¹⁴,¹⁷

A sudden impedance change matters because it can indicate an open circuit, a short circuit, a connector issue, or an IPG fault, and those scenarios can directly affect whether stimulation is delivered as intended.¹⁴,¹⁷–¹⁹ Impedance also matters differently depending on whether a system is constant-current or constant-voltage, because impedance shifts can change delivered current in constant-voltage devices, while constant-current devices adjust voltage to maintain current within limits.¹⁴,¹⁷

In practice, your medical team often compare multiple impedance measures, including “lead integrity” and “therapeutic” impedance, because they capture different parts of the system and can point to different fault locations.¹⁴,¹⁷

When impedance is abnormal, published troubleshooting approaches emphasize a staged evaluation rather than immediate surgery, because some failures are localized to the IPG connector block or can be clarified with imaging and repeated measurements.¹⁴,¹⁷–¹⁹

Very high impedance values can suggest an open circuit, which can occur with fractures, loose connections, or internal IPG issues, and case reports describe situations where IPG replacement corrected abrupt high-impedance loss of benefit when imaging showed no macroscopic fracture.¹⁹

Very low impedance values can suggest a short circuit, which has been associated with insidious symptom change and shortened battery longevity, and programming changes can sometimes compensate depending on which contacts are involved.¹⁸ If a patient hears “impedance changed,” the most practical next step is to ask which measure changed, which contacts were affected, whether the change was sudden or gradual across visits, and what the clinic’s algorithm is for confirming and localizing the issue.¹⁴,¹⁷,¹⁹

The association between impedance extremes and circuit problems is well-established, but specific thresholds and management differ across manufacturers, measurement modes, and device designs.¹⁴,¹⁷–¹⁹

Glossary:

Impedance: Electrical resistance in the DBS circuit, used to assess hardware and electrode-tissue interface behavior.¹⁴,¹⁷

Lead integrity impedance: A measurement aimed at detecting circuit continuity problems, sometimes distinct from therapeutic impedance.¹⁴,¹⁷

Therapeutic impedance: A measurement related to the actual programmed stimulation configuration and delivered output.¹⁴,¹⁷

Connector block: The component where the lead or extension interfaces with the IPG, and a possible site of disconnection or fault.¹⁹

Question 13

What should I do after a fall, accident, or major chest/neck strain, even if I feel fine?

Accepted Answer

After a significant fall or strain event, the main issue is that DBS hardware runs from the skull through the neck to the chest or abdomen, and mechanical forces can stress connectors, extensions, or lead anchoring points even if you do not feel immediate device-related symptoms.¹⁶,²⁵

Some hardware problems, such as intermittent connection or gradual fracture evolution, can present later as fluctuating benefit, unexpected side effects, or abnormal impedance measurements.¹⁶,²⁵ The safest framing is to treat the event as something worth documenting and communicating, not as proof that damage occurred.¹⁶

A second issue is personal safety, because any injury with head impact, new neurologic symptoms, or severe pain warrants medical evaluation independent of DBS, and DBS status should be shared with the evaluating team.¹⁶,⁸

A practical approach is to record the date, how your injury happened, and any new symptoms, then contact your DBS clinic for guidance on whether device interrogation or imaging is needed.¹–³,¹⁶ If you notice a new pattern such as sudden loss of benefit, new stimulation sensations at unchanged settings, or controller communication problems after the event, this increases the likelihood that a device check will be useful.¹–³,¹⁵

Hardware complication reviews describe fractures, migrations, and connector issues among the spectrum of DBS complications, and these can require different responses depending on location and severity.¹⁶,²⁵ When imaging is considered, the choice of modality must follow device labeling, especially for MRI, because MRI access depends on the exact implanted system and region-specific labeling conditions.⁶–¹⁰,¹¹–¹³

Mechanical strain as a contributor to hardware problems is biologically plausible and supported by hardware complication literature, but most individual events do not result in device failure, and confirmation requires clinician interrogation.¹⁶,²⁵

Glossary:

Extension: The insulated wire connecting the brain lead to the IPG, usually routed under the skin along the neck.¹⁶

Intermittent connection: A partial or position-dependent circuit problem that can cause fluctuating stimulation delivery.¹⁶

Device interrogation: Clinician check of battery, impedances, and programmed settings to assess function.¹–³

Labeling: Official device documents that define what procedures and imaging are permitted and under what conditions.⁶–¹⁰

Question 14

What should I know about safety around medical and dental procedures, X-rays, CT, ultrasound, MRI rules, and what to tell staff?

Accepted Answer

Safety around procedures is mostly about energy sources and how they might interact with implanted leads and the IPG, because the system can act as a pathway for unintended energy transfer.⁶–¹⁰

Many procedures are safe with routine precautions, while a smaller set require strict device-specific steps, and a few are contraindicated because they have caused serious harm in implanted neurostimulation systems.⁶–¹⁰ The most important principle is that safety rules are not generic “DBS rules,” they are device-model and configuration specific, and they come from manufacturer labeling recognized by regulators in your region.⁶–¹³ Clinicians and staff should be told that you have an implanted DBS system, the manufacturer and model, implant locations, and whether the system is MRI-conditional under specific conditions.⁶–¹⁰

For common diagnostic imaging, X-rays and CT scans are generally considered compatible with DBS systems, but it is still important to inform imaging staff so they can follow facility protocols and avoid unnecessary device exposure or misinterpretation of artifacts.⁶–¹⁰ Ultrasound is more nuanced because diagnostic ultrasound is usually not the same as therapeutic ultrasound diathermy, and diathermy is specifically contraindicated in DBS labeling because of the risk of energy transfer, tissue heating, device damage, and severe injury.⁶,⁹,¹⁰ MRI requires the most careful planning, because MRI safety depends on exact system components, lead configuration, implant locations, and manufacturer-specified scanning conditions such as field strength and coil type, and these requirements can differ across manufacturers and across regions.⁶–¹⁰,¹¹–¹³

If you travel or receive care outside your usual health system, do not assume MRI rules are the same internationally, because labeling language and regulatory pathways differ, for example FDA labeling in the US, CE marking under EU pathways, UKCA marking in Great Britain, Health Canada device licensing, or Australia’s ARTG inclusion, and staff may be more familiar with local systems than with yours.⁶,¹¹–¹³

Diathermy contraindications and MRI-conditional rules are explicitly stated in manufacturer labeling, while other procedure precautions can vary by facility policy and evolving device designs.⁶–¹⁰

Glossary:

MRI-conditional: A labeling category meaning MRI can be performed only under specified conditions defined by the manufacturer.⁶–¹⁰

Diathermy: Shortwave, microwave, or therapeutic ultrasound energy used for deep heating, contraindicated for DBS in multiple manufacturers’ labeling.⁶,⁹,¹⁰

Artifact: Distortion on imaging caused by the presence of metal or electronics, which can affect interpretation.⁶–¹⁰

Regulatory pathway: The region-specific process that determines how devices are authorized and labeled, influencing the exact wording clinicians rely on.¹¹–¹³

Question 15

What procedures are higher-risk for DBS systems, diathermy, electrocautery, TENS, e-stim, and why?

Accepted Answer

Higher-risk procedures are those that introduce electrical current or electromagnetic energy that can couple into the DBS system, potentially causing heating at the electrode contacts, device malfunction, unintended stimulation, or reprogramming.⁶–¹⁰,³,⁷

Risk is not only about discomfort, it can be about tissue injury in the brain or damage to implanted components, and those risks are the reason certain procedures are listed as contraindications in labeling.⁶,⁹,¹⁰ Diathermy is the clearest example, because multiple DBS manufacturer documents explicitly contraindicate shortwave, microwave, and therapeutic ultrasound diathermy due to severe injury risk.⁶,⁹,¹⁰ Electrosurgery, including electrocautery and electrosurgical units, can create electromagnetic interference and current pathways that interact with implanted devices, so it requires procedural planning rather than last-minute decisions.³,⁷,²⁴

Electrocautery precautions are often framed around using bipolar techniques when possible, using the lowest effective settings, limiting activation duration, and placing return electrodes so current paths avoid the IPG and leads, because that reduces the chance current travels through the neurostimulation system.⁷,³

TENS and other external electrical stimulation modalities are harder to generalize, because devices vary and not all combinations have been tested, so a cautious approach is to treat them as potential sources of interference and to request guidance from the DBS clinic and the device manufacturer for your specific model.³,³⁰

Some academic centers have published local safety guidance for dental and rehabilitation settings, but these documents are not substitutes for manufacturer labeling, and they often emphasize contacting the DBS team and using the lowest effective settings with careful device distance when external energy devices are used.³¹
Diathermy contraindications and electrosurgery precautions are supported by labeling and perioperative safety guidance, while evidence for specific external stimulators like TENS is less uniform and often relies on cautious, device-specific recommendations.⁶,⁷,⁹,¹⁰,³

Glossary:

Electrocautery: A surgical method using electrical energy for cutting or coagulation, which can interfere with implanted stimulators.³,⁷

Bipolar cautery: Electrosurgery where current travels between two closely spaced electrodes, generally reducing stray current paths compared with monopolar.⁷

Return electrode: The pad used in monopolar electrosurgery to complete the circuit, where placement can reduce risk to implants.⁷

Electromagnetic interference: External electromagnetic energy that can disrupt device sensing, output, or programming.³

Question 16

What is the safest way to approach physical therapy, chiropractic care, massage, and pain clinic treatments with an implant?

Accepted Answer

Rehabilitation and pain treatments matter after DBS because physical function, gait, balance, and musculoskeletal pain often determine quality of life as much as tremor control does.⁴,²⁰

Most hands-on therapies are compatible with DBS, but certain modalities used in pain clinics and some PT settings involve electrical stimulation, heating devices, or strong magnets that can interact with implanted components.³,⁶–¹⁰

The first safety step is communication: tell the therapist what is implanted, where the IPG pocket is, where the extension runs, and which modalities you should avoid based on your device labeling.⁶–¹⁰ 
The second step is planning: if a clinic proposes a modality that uses electrical energy, radiofrequency, or deep heating, it should be cleared with the DBS team because labeling contraindications exist for some energy-based therapies.⁶,⁹,¹⁰

For manual therapies such as massage, the main practical consideration is avoiding direct, aggressive pressure over the IPG pocket and along the extension tract if it causes pain, skin irritation, or a sense of tugging, because discomfort can signal local tissue stress even without device malfunction.¹⁶

For chiropractic manipulation, the evidence base is limited, so the safest approach is to disclose the implant, avoid maneuvers that involve extreme neck forces near extension routing, and ask your DBS team if you have any device-specific restrictions based on your surgical routing and healing status.¹⁶

For pain clinic procedures, caution is higher with modalities like radiofrequency ablation, electrosurgery, or external electrical stimulation, and perioperative safety guidance for non-cardiac implantable electrical devices emphasizes preoperative planning and minimizing current paths near the device.⁷,³

General safety principles for avoiding contraindicated energy modalities are clear in labeling, while data comparing specific rehabilitation techniques in DBS patients is limited and often relies on cautious expert practice.⁶–¹⁰,⁷

Glossary:

IPG pocket: The tissue space where the stimulator is implanted, commonly in the chest, which can be sensitive to pressure.¹⁶

Extension tract: The subcutaneous path of the extension wire, usually along the neck, where strain can cause discomfort.¹⁶

Energy-based modality: A therapy using electrical, electromagnetic, or deep heating energy that can interact with implanted devices.⁶–¹⁰

Preoperative planning: Coordinating device precautions before a procedure to reduce risk of interference or injury.⁷

Question 17

What does “electromagnetic interference” mean for DBS, and what everyday items rarely matter versus sometimes matter?

Accepted Answer

Electromagnetic interference, also called EMI, refers to external electromagnetic fields that can disrupt how an implanted device operates, including unintended changes in stimulation, device inhibition, or device resets in some circumstances.³

Modern DBS systems are engineered to resist many common environmental fields, but certain sources can still cause transient effects, especially when the source is close to the IPG or leads.³ Manufacturer and clinical reviews emphasize that most consumer electronics are safe at typical distances, but they also recommend practical precautions around strong magnets, industrial equipment, and certain security systems.³,⁶–¹⁰ The goal is not to avoid daily life, it is to understand which exposures are plausible enough to plan around.³

In practice, items that rarely matter are those with low field strength or brief exposure at a distance, such as household appliances in normal operation, while items that sometimes matter include strong magnets, anti-theft gates, metal detectors, and high-power industrial equipment, particularly if you linger close to the source or press the implant site against it.³,⁶–¹⁰ Some manufacturers warn against “therapeutic magnets” sold in consumer products because magnets can unintentionally turn therapy on or off or change device states depending on system design.³²

EMI discussions are also evolving as rechargeable systems and wireless telemetry become more common, and regulator and manufacturer communications sometimes address specific behaviors such as device resets during charging for certain models, which is a different mechanism than environmental EMI but can feel similar to patients because it produces abrupt symptom change.²⁸,²⁹

EMI principles and many practical precautions are well-described in clinical reviews and manufacturer labeling, but exact susceptibility differs by device generation, telemetry design, and implant configuration.³,⁶–¹⁰

Glossary:

Electromagnetic interference: External electromagnetic energy that can disrupt DBS function or cause transient device effects.³

Telemetry: Wireless communication between the patient controller or clinician programmer and the implanted device.¹–³

Therapeutic magnet: Consumer magnet products marketed for pain or wellness, which manufacturers may warn against due to device interaction risk.³²

Device reset: An unexpected return of device state that can interrupt therapy, sometimes addressed in manufacturer advisories or regulator notices.²⁸,²⁹

Question 18

What should I keep in a DBS “device information kit”?

Accepted Answer

A device information kit is a safety tool that reduces delay and confusion during urgent care, travel, or unplanned procedures, especially when the treating team is unfamiliar with your specific DBS model.⁶–¹⁰

MRI conditions, contraindicated procedures, and even how to check therapy status depend on manufacturer and model, and in emergency settings clinicians often need accurate information quickly.⁶–¹⁰ A kit also supports continuity of care across borders, since DBS labeling and regulatory language vary internationally, and clinicians in one country may not recognize device documentation formats from another.⁶,¹¹–¹³ The most useful kit is compact, updated, and easy to access without relying on memory.¹–³

A well-prepared kit focuses on identification, safety labeling, and communication pathways that clinicians can use immediately.⁶–¹⁰
 • Implant identification information should include your manufacturer, model names or numbers for the IPG and leads if available, implant locations, implant dates, and your implant card, because these elements allow staff to find correct MRI and procedure guidelines.⁶–¹⁰ Keep both physical and digital copies when possible, because phones can die and paper can be lost, and redundancy reduces risk during travel.⁶–¹⁰
 • A settings summary should include the name of your active program and any clinician-approved patient-adjustable ranges, plus the date of the last programming change, because this helps clinicians understand what “normal” was before a problem started.¹–³ If you do not have a settings printout, ask your clinic what they can provide, since many centers can generate a visit summary from the programmer.¹–³
 • A contacts and escalation plan should include your DBS clinic phone number, after-hours instructions, device manufacturer support line for your region, and a short statement about key contraindications such as diathermy and device-specific MRI rules.⁶–¹⁰ This is not a substitute for emergency services, but it helps emergency teams coordinate appropriate device-safe decisions.⁶–¹⁰ If you travel, include region-appropriate labeling or links, because MRI support pages and manuals can differ by country site and may require the exact system family.⁶–¹⁰
The value of carrying implant identification and MRI-conditional documentation is clear in labeling and perioperative guidance, while the exact contents of a “kit” are not standardized and should be adapted to your clinic’s workflow.⁶–¹⁰,⁷

Glossary:

Implant card: Manufacturer-provided identification card listing implanted device details used for safety and verification.⁶–¹⁰

Settings summary: A record of current DBS program parameters and recent changes, used for troubleshooting and continuity.¹–³

Manufacturer support: Company resources that provide device-specific MRI and procedure guidelines, often region-specific.⁶–¹⁰

Escalation plan: A written plan for who to contact and what information to provide when symptoms or device issues arise.¹–³

Question 19

What can long-term DBS maintenance look like year to year?

Accepted Answer

Long-term DBS maintenance is a planned cycle of follow-up rather than a one-time “set it and forget it” therapy, because symptoms evolve and the stimulation-medication balance often needs revisiting.¹–⁵

Long-term outcomes depend not only on the implanted hardware lasting, but on clinical benefit staying aligned with a person’s changing goals and disease stage.⁴,⁵ Maintenance also includes anticipating battery replacement or managing recharge routines, since therapy interruption from battery depletion can present as a sudden symptom return.¹–³ Many expert reviews emphasize multidisciplinary follow-up, because programming, medication management, rehabilitation, and psychosocial support interact over time.⁴,⁵,²⁰

Year-to-year care often includes periodic device interrogation to assess battery status, impedances, and any alerts, plus symptom review using structured history or rating tools when appropriate.¹–³,¹⁴ 
A symptom tracking approach that focuses on a few meaningful daily-life outcomes, such as walking stability, speech clarity, tremor interference, sleep quality, or medication “off” time, is often more actionable than tracking dozens of variables.¹–³,⁴

Some medical teams schedule “optimization windows” when symptoms drift, because re-mapping contacts and re-testing thresholds can restore benefit, especially when earlier programming was constrained by healing-phase variability.¹–³,²⁶,²⁷ In addition, manufacturers and regulators sometimes publish advisories or updates relevant to certain implanted models, and staying connected to your implanting center helps ensure you receive device-specific guidance when it applies.²⁸,²⁹
The need for periodic re-optimization and battery planning is well-recognized, but the ideal visit frequency varies by condition, device type, and access to specialized DBS care.¹–⁵

Glossary:

Maintenance: Ongoing follow-up that includes device checks, symptom assessment, and adjustments as needed over time.¹–³

Battery planning: Anticipating replacement for non-rechargeable systems or establishing reliable recharge routines for rechargeable systems.¹–³

Re-optimization: A structured process of adjusting contacts and parameters to regain the best balance of benefit and side effects.¹–³
 
Multidisciplinary care: Coordinated care involving neurology, neurosurgery, rehabilitation, and other supports as needed.⁴,⁵

Question 20

What is a “tune-up,” and why do settings often need revisiting over the years?

Accepted Answer

A “tune-up” is a planned re-evaluation of DBS settings to match current symptoms, side-effect thresholds, and daily-life priorities, using systematic testing rather than random adjustments.¹–³

Even when hardware is stable, symptom targets can shift, medication regimens change, and electrode-tissue interface properties evolve, which can all change the effective therapeutic window.¹–⁵,¹⁴ Some people need tune-ups because new symptoms emerge that were not major problems at the time of implant, while others need tune-ups because a previously good setting begins to trade benefit for side effects such as speech or balance issues.²⁰,²¹ Tune-ups are also common after major life changes, such as new job demands, changes in activity level, or recovery from unrelated illness, because functional goals can change even if core symptoms do not.¹–³

Your medical team will often approach a tune-up by confirming the current “best” contact and program, then exploring whether small parameter changes can widen the therapeutic window.¹–³ Parameter selection principles are based on neurostimulation fundamentals, including how amplitude, pulse width, and frequency shape neural recruitment and side-effect thresholds.²¹

When directional stimulation is available, clinicians may steer current to reduce side effects while preserving benefit, although the degree of advantage varies by anatomy and symptom target.²,²² A tune-up can also include a medication review, because medication reduction after DBS can improve dyskinesias for some but can worsen other features for others, and these interactions can change over time.⁴,²³

The clinical need for periodic reprogramming is widely supported, but predicting when a tune-up will be required is difficult because it depends on both biology and life context.¹–⁵,²⁰

Glossary:

Tune-up: A structured DBS programming review aimed at restoring or improving the benefit-to-side-effect balance.¹–³

Amplitude: The strength of stimulation, often the parameter most associated with both symptom benefit and side effects.¹–³,²¹

Pulse width: The duration of each stimulation pulse, which can change which neural elements are recruited at a given amplitude.²¹

Frequency: The rate of pulses per second, which can influence symptom response patterns and side effects in target-specific ways.¹–³,²¹

Question 21

What is the difference between hardware longevity and clinical longevity, device life vs sustained benefit?

Accepted Answer

Hardware longevity refers to how long the implanted components function within specifications, including battery life, lead integrity, and the absence of device faults.¹⁴,¹⁶

A device can remain mechanically and electrically functional while the clinical benefit changes due to disease progression, symptom shifts, or evolving goals, which is clinical longevity.⁴,⁵ Clinical longevity is not a single number, because different symptoms have different DBS responsiveness, and some symptoms become less responsive over time even if tremor or rigidity remains improved.⁴,⁵,²⁰ Separating these concepts helps avoid a common confusion, which is interpreting new disability as proof of hardware failure without checking whether the device is delivering therapy as programmed.¹–³,¹⁵

Clinically, your medical team will often evaluate hardware longevity through interrogation data, including battery status and impedance stability, while clinical longevity is evaluated through symptom tracking, functional assessments, and quality-of-life outcomes.¹–³,¹⁴ When benefit declines, the first question is often whether therapy delivery changed, which includes checking for therapy-off states, battery depletion, abnormal impedance patterns, or device resets, because those can mimic disease progression.¹–³,¹⁴,²⁸

If hardware is stable, clinicians then evaluate whether the symptom target shifted, whether medication changes are contributing, and whether reprogramming can improve the new balance.¹–⁵ If neither optimization nor medication adjustments restore function, the discussion may move toward realistic expectations, rehabilitation strategies, and supportive care planning, because DBS is one part of a longer disease course.⁴,⁵

The conceptual distinction between hardware function and clinical benefit is well-accepted in DBS practice, but long-term trajectories vary widely by condition, target, and individual biology.⁴,⁵,¹⁵,¹⁶

Glossary:

Hardware longevity: The duration that implanted DBS components function properly without failure.¹⁶

Clinical longevity: The duration that DBS provides meaningful symptom or functional benefit aligned with goals.⁴,⁵

Interrogation data: Objective device measurements, such as battery status and impedances, used to assess hardware function.¹–³,¹⁴

Quality of life: A person’s perceived functioning and well-being, often influenced by both motor and non-motor symptoms.⁴,⁵

Question 22

Sources

Accepted Answer

1. Shukla AW, Zeilman P, Fernandez H, Bajwa JA, Mehanna R. DBS Programming: An Evolving Approach for Patients With Parkinson’s Disease. Parkinsons Dis. 2017;2017:8492619. doi:10.1155/2017/8492619. PMID: 29147598. https://pubmed.ncbi.nlm.nih.gov/29147598/
(https://pubmed.ncbi.nlm.nih.gov/29147598/?utm_source=chatgpt.com)
2. Koeglsperger T, Palleis C, Hell F, Mehrkens JH, Bötzel K. Deep Brain Stimulation Programming for Movement Disorders: Current Concepts and Evidence-Based Strategies. Front Neurol. 2019;10:410. doi:10.3389/fneur.2019.00410. PMID: 31231293. https://pubmed.ncbi.nlm.nih.gov/31231293/ (https://pubmed.ncbi.nlm.nih.gov/31231293/?utm_source=chatgpt.com)
3. Rahimpour S, Razavi S, Rezaei M, et al. Deep brain stimulation and electromagnetic interference. Clin Neurol Neurosurg. 2021;203:106577. doi:10.1016/j.clineuro.2021.106577. PMID: 33662743. https://pubmed.ncbi.nlm.nih.gov/33662743/ (https://pubmed.ncbi.nlm.nih.gov/33662743/?utm_source=chatgpt.com)
4. Hariz M, Blomstedt P. Deep brain stimulation for Parkinson’s disease. J Intern Med. 2022;292(5):764-778. doi:10.1111/joim.13541. PMID: 35798568. https://pubmed.ncbi.nlm.nih.gov/35798568/ (https://pubmed.ncbi.nlm.nih.gov/35798568/?utm_source=chatgpt.com)
5. Groiss SJ, Wojtecki L, Südmeyer M, Schnitzler A. Deep Brain Stimulation in Parkinson’s Disease. Ther Adv Neurol Disord. 2009;2(6):379-391. doi:10.1177/1756285609349469. PMCID: PMC3002606. https://pmc.ncbi.nlm.nih.gov/articles/PMC3002606/ (https://pmc.ncbi.nlm.nih.gov/articles/PMC3002606/?utm_source=chatgpt.com)
6. Medtronic. DBS for Parkinson’s Disease: Important Safety Information. https://www.medtronic.com/en-us/l/patients/treatments-therapies/deep-brain-stimulation-parkinsons-disease/important-safety-information.html (https://www.medtronic.com/en-us/l/patients/treatments-therapies/deep-brain-stimulation-parkinsons-disease/important-safety-information.html?utm_source=chatgpt.com)
7. Morano JM. Recommendations for Managing Non-Cardiac Implantable Electrical Devices (NCIEDs) During Non-Neurologic Surgery and Procedures. Anesthesia Patient Safety Foundation. https://www.apsf.org/article/recommendations-for-managing-non-cardiac-implantable-electrical-devices-ncieds-during-non-neurologic-surgery-and-procedures/ (https://www.apsf.org/article/recommendations-for-managing-non-cardiac-implantable-electrical-devices-ncieds-during-non-neurologic-surgery-and-procedures/?utm_source=chatgpt.com)
8. Abbott. Important Safety Information, Neuromodulation. https://www.neuromodulation.abbott/us/en/important-safety-information.html (https://www.neuromodulation.abbott/us/en/important-safety-information.html?utm_source=chatgpt.com)
9. Boston Scientific. Vercise Deep Brain Stimulation Systems, Information for Prescribers. 92932013-02. https://www.bostonscientific.com/content/dam/elabeling/nm/vercise/92932013-02A_VERCISE_DBS_SYSTEMS_IFU_ML_s.pdf (https://www.bostonscientific.com/content/dam/elabeling/nm/vercise/92932013-02A_VERCISE_DBS_SYSTEMS_IFU_ML_s.pdf?utm_source=chatgpt.com)
10. Abbott. MRI Support, DBS Systems (MR Conditional). https://www.neuromodulation.abbott/int/en/healthcare-professionals/mri-support.html (https://www.neuromodulation.abbott/int/en/healthcare-professionals/mri-support.html?utm_source=chatgpt.com)
11. European Commission, Public Health. Notified bodies for medical devices. https://health.ec.europa.eu/medical-devices-topics-interest/notified-bodies-medical-devices_en (https://health.ec.europa.eu/medical-devices-topics-interest/notified-bodies-medical-devices_en?utm_source=chatgpt.com)
12. UK Government. Medical devices: conformity assessment and the UKCA mark. https://www.gov.uk/guidance/medical-devices-conformity-assessment-and-the-ukca-mark (https://www.gov.uk/guidance/medical-devices-conformity-assessment-and-the-ukca-mark?utm_source=chatgpt.com)
13. Health Canada. Guidance for determining medical device application type. https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-devices/application-information/guidance-documents/guidance-determining-medical-device-application-type.html (https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-devices/application-information/guidance-documents/guidance-determining-medical-device-application-type.html?utm_source=chatgpt.com)
14. Deeb W, Patel A, Okun MS, Gunduz A. Management of Elevated Therapeutic Impedances on Deep Brain Stimulation Leads. Tremor Other Hyperkinet Mov (N Y). 2017;7:493. doi:10.5334/tohm.370. PMID: 28983423. https://pubmed.ncbi.nlm.nih.gov/28983423/ (https://pubmed.ncbi.nlm.nih.gov/28983423/?utm_source=chatgpt.com)
15. Okun MS, Tagliati M, Pourfar M, et al. Management of referred deep brain stimulation failures: a retrospective analysis from 2 movement disorders centers. Arch Neurol. 2005;62(8):1250-1255. doi:10.1001/archneur.62.8.1250. PMID: 15956104. https://pubmed.ncbi.nlm.nih.gov/15956104/ (https://pubmed.ncbi.nlm.nih.gov/15956104/?utm_source=chatgpt.com)
16. Baizabal-Carvallo JF, Simpson RK, Jankovic J. Diagnosis and treatment of complications related to deep brain stimulation hardware. Mov Disord. 2011;26(8):1398-1406. doi:10.1002/mds.23681. PMID: 21714001. https://pubmed.ncbi.nlm.nih.gov/21714001/ (https://pubmed.ncbi.nlm.nih.gov/21714001/?utm_source=chatgpt.com)
17. Kuncel AM, Grill WM. Selection of stimulus parameters for deep brain stimulation. Clin Neurophysiol. 2004;115(11):2431-2441. doi:10.1016/j.clinph.2004.05.031. PMID: 15465430. https://pubmed.ncbi.nlm.nih.gov/15465430/ (https://pubmed.ncbi.nlm.nih.gov/15465430/?utm_source=chatgpt.com)
18. Samura K, Miyagi Y, Okamoto T, et al. Short circuit in deep brain stimulation. J Neurosurg. 2012;117(5):955-961. doi:10.3171/2012.8.JNS112073. PMID: 22957525. https://pubmed.ncbi.nlm.nih.gov/22957525/ (https://pubmed.ncbi.nlm.nih.gov/22957525/?utm_source=chatgpt.com)
19. Yang HJ, Yun JY, Kim HJ, Jeon BS, Paek SH. Sudden loss of the deep brain stimulation effect with high impedance without macroscopic fracture: a case report and review of the published literature. Neuropsychiatr Dis Treat. 2015;11:179-184. doi:10.2147/NDT.S86120. PMID: 26229475. PMCID: PMC4516336. https://pubmed.ncbi.nlm.nih.gov/26229475/ (https://pubmed.ncbi.nlm.nih.gov/26229475/?utm_source=chatgpt.com)
20. Bronstein JM, Tagliati M, Alterman RL, et al. Deep Brain Stimulation for Parkinson Disease: An Expert Consensus and Review of Key Issues. Arch Neurol. 2011;68(2):165-171. https://jamanetwork.com/journals/jamaneurology/fullarticle/802237 (https://jamanetwork.com/journals/jamaneurology/fullarticle/802237?utm_source=chatgpt.com)
21. Fox SH, Katzenschlager R, Lim SY, et al. International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson’s disease. Mov Disord. 2018;33(8):1248-1266. doi:10.1002/mds.27372. PMID: 29570866. https://pubmed.ncbi.nlm.nih.gov/29570866/ (https://pubmed.ncbi.nlm.nih.gov/29570866/?utm_source=chatgpt.com)
22. Martinez-Nunez AE, Shahed J, et al. Management of essential tremor deep brain stimulation: clinical review. Front Hum Neurosci. 2024;18:1353150. doi:10.3389/fnhum.2024.1353150. https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2024.1353150/full (https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2024.1353150/full?utm_source=chatgpt.com)
23. Pandey S, Srivanitchapoom P. Levodopa-induced dyskinesia: Clinical features, pathophysiology, and medical management. Ann Indian Acad Neurol. 2017;20(3):190-198. doi:10.4103/aian.AIAN_239_17. PMCID: PMC5586110. https://pmc.ncbi.nlm.nih.gov/articles/PMC5586110/ (https://pmc.ncbi.nlm.nih.gov/articles/PMC5586110/?utm_source=chatgpt.com)
24. Brodsky MA, Hogarth P, Nutt JG. OFF-off rebound dyskinesia in subthalamic nucleus deep brain stimulation of Parkinson’s disease. Mov Disord. 2006;21(9):1487-1490. doi:10.1002/mds.20964. PMID: 16721730. https://pubmed.ncbi.nlm.nih.gov/16721730/ (https://pubmed.ncbi.nlm.nih.gov/16721730/?utm_source=chatgpt.com)
25. Jitkritsadakul O, Bhidayasiri R, et al. Systematic review of hardware-related complications of deep brain stimulation. Brain Stimul. 2017;10(3): 529-542. https://www.brainstimjrnl.com/article/S1935-861X(17)30843-4/abstract ()
26. Tykocki T, Nauman P, Koziara H, Mandat T. Microlesion effect as a predictor of the effectiveness of subthalamic deep brain stimulation for Parkinson’s disease. Stereotact Funct Neurosurg. 2013;91(1):12-17. doi:10.1159/000342161. PMID: 23154788. https://pubmed.ncbi.nlm.nih.gov/23154788/ (https://pubmed.ncbi.nlm.nih.gov/23154788/?utm_source=chatgpt.com)
27. Hamani C, Davidson B, Lipsman N, et al. Insertional effect following electrode implantation: an underreported but important phenomenon. Brain Commun. 2024;6(3):fcae093. doi:10.1093/braincomms/fcae093. PMID: 38707711. PMCID: PMC11069120. https://pubmed.ncbi.nlm.nih.gov/38707711/ (https://pubmed.ncbi.nlm.nih.gov/38707711/?utm_source=chatgpt.com)
28. US Food and Drug Administration. Class 2 Device Recall: Vercise Genus, R16 and R32 (reset during charging, transient loss of stimulation). https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRes/res.cfm?id=207089 (https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRes/res.cfm?id=207089&utm_source=chatgpt.com)
29. Boston Scientific. Urgent Medical Device Advisory: DBS Effects Resets Rechargeable IPGs (Physician Letter, April 18, 2024). https://www.bostonscientific.com/content/dam/bostonscientific/quality/documents/Recent%20Product%20Advisories/2024_April_DBSEffectsResetsRechargeableIPGs_PhysLtr.pdf (https://www.bostonscientific.com/content/dam/bostonscientific/quality/documents/Recent%20Product%20Advisories/2024_April_DBSEffectsResetsRechargeableIPGs_PhysLtr.pdf?utm_source=chatgpt.com)
30. Pacific Neuroscience Institute. 25 Questions About Deep Brain Stimulation (Part 3/3), TENS question. https://www.pacificneuroscienceinstitute.org/blog/movement-disorders/25-questions-about-deep-brain-stimulation-part-3-3/ (https://www.pacificneuroscienceinstitute.org/blog/movement-disorders/25-questions-about-deep-brain-stimulation-part-3-3/?utm_source=chatgpt.com)
31. UC Davis Health. DBS Medical Safety Issues (patient guidance PDF). https://health.ucdavis.edu/media-resources/neurology/documents/pdfs/pd-dbs/dbs-medical-safety-issues.pdf (https://health.ucdavis.edu/media-resources/neurology/documents/pdfs/pd-dbs/dbs-medical-safety-issues.pdf?utm_source=chatgpt.com)
32. Abbott. Neuromodulation: Therapeutic magnets warning (corporate article). https://www.abbott.com/en-us/corpnewsroom/pain-and-movement/neuromodulation-overcoming-the-isolation-of-pain (https://www.abbott.com/en-us/corpnewsroom/pain-and-movement/neuromodulation-overcoming-the-isolation-of-pain?utm_source=chatgpt.com)

DEEP BRAIN STIMULATION

DBS PROGRAMMING

BACK TO DBS HUB | BACK TO DBS DEEP DIVE

DBS Symptom, Safety, and Support

INFORMATION COMING SOON!

DON'T TAKE OUR WORD FOR IT . . .

CONNECT WITH US

JOIN OUR MAILING LIST