Reversible neurological symptoms caused by diathermy in a patient with deep brain stimulators: case report

Diathermy is contraindicated in patients with implanted deep brain stimulation (DBS) electrodes. As the clinical applications for diathermy and the number of patients with DBS implants continue to grow, the opportunity for diathermy-induced complications in the population with DBS electrodes increases. We report a case of reversible neurological deficit in a patient who underwent diathermy 4 years after implantation of bilateral DBS leads.

A 58-year-old man with well-controlled symptoms of Parkinson's disease after the placement of bilateral DBS systems went to his primary care physician for the treatment of recurrent neck pain. A course of diathermy was prescribed, and after the second treatment, the patient developed double-vision and severe right-sided motor contractions. These symptoms resolved when he turned off the implanted pulse generators.

The implanted pulse generators were turned back on after several days, but the symptoms recurred within 48 hours. The voltages were therefore decreased, resulting in resolution of symptoms but suboptimal control of the Parkinson's disease. A magnetic resonance imaging scan of the brain showed a small amount of edema surrounding the contacts of the left-sided lead. A follow-up magnetic resonance imaging scan 4 weeks later disclosed interval reduction in the edema, and the patient was able to tolerate increased voltage without symptom recurrence.

This is the first reported case of reversible injury from diathermy in a patient with DBS implants. Neurosurgeons must continue to emphasize to their patients and to other practitioners treating this population that diathermy is contraindicated for those with DBS implants.