Charging failure due to pulse generator rotation after deep brain stimulation: a case report

A 54-year-old man with Parkinson's disease presented with gait instability and difficulty charging his rechargeable deep brain stimulation (DBS) pulse generator. Chest radiography revealed horizontal rotation and anterior-to-posterior inversion of the device within the subcutaneous pocket, which was not seen in prior imaging. Surgical revision confirmed the device malorientation, and repositioning restored charging efficiency. This case highlights that pulse generator rotation, a rare but relevant hardware complication, can cause charging difficulties despite normal device interrogation. It underscores the importance of considering mechanical causes and using chest imaging in postoperative assessments.