Denial of Hardware-Related Skin Erosion in Patients with Effective Deep Brain Stimulation: A Novel Phenomenon

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.

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.

Overall, 5 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, 54-78). Three patients had dystonia; 2 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, 5-264 months). Despite multiple surgical attempts at preservation, the neurostimulation system was ultimately explanted in 3 patients.

Denial toward hardware-related skin erosion in DBS, most probably denial, is a rare but potentially serious complication during chronic DBS.