Two people with Parkinson's disease in Finland fell into the same medical emergency when the batteries in their brain stimulators ran dry. One had a new pulse generator implanted two days after symptoms began and made a complete recovery. The other waited 14 days, never meaningfully recovered, and died two and a half years later in a nursing home.
Neurologists at the University of Turku and Turku University Hospital described both patients on June 9 in Case Reports in Neurology. Their report adds to a small but sobering collection of cases showing that when deep brain stimulation (DBS) stops without warning, the fallout can range from an awkward public moment to a life-threatening crisis.
Two Dead Batteries, Two Very Different Outcomes
DBS treats movement disorders with electrodes placed deep in the brain, powered by a pulse generator implanted in the chest. In Parkinson's disease, a sudden loss of stimulation can trigger DBS withdrawal syndrome, an akinetic crisis marked by severe rigidity, fever, unstable heart rate and blood pressure, confusion and a rise in creatine kinase, an enzyme that leaks from damaged muscle.
The first Finnish patient, in their late 50s, had lived with Parkinson's for 11 years and with DBS for four. The patient developed sudden stiffness and slowness, trouble swallowing and speaking, fever and elevated infection markers, and doctors first suspected pneumonia. The dead battery was identified the day after admission, but replacement was postponed until 14 days after symptoms began because of a suspected bacterial infection. The patient remained permanently bedridden with severe speech and swallowing problems, developed repeated aspiration pneumonias, and needed a feeding tube.
The second patient, in their mid-60s, had had Parkinson's for 27 years and DBS for 14. This patient arrived with worsening tremor, rigidity and slowness, fever and a creatine kinase level of 13,705 U/L. Rescue doses of Parkinson's medication and other conservative measures did not help. A new generator went in two days after symptoms started, and the patient recovered completely.
The authors wrote that the stark contrast between the two outcomes underscores the importance of restoring stimulation promptly. The first patient's suspected infection also complicated care, however, and two cases cannot show exactly how much the delay alone mattered.
A Patient Who Did Not Fit the Risk Profile
The first case surprised the researchers for another reason. Severe withdrawal syndrome has been tied to three main risk factors: older age, Parkinson's lasting more than 15 years, and more than five years of stimulation. Among 45 previously published cases the team reviewed, 22 patients had all three factors, and 19 had two. The first Finnish patient had none.
What that patient did have was unusually strong stimulation, 4.1 volts on each side, compared with an average of about 3.0 volts in earlier reported cases. Imaging also showed slightly suboptimal electrode placement, which may explain why so much current was needed. The authors suggested that high amplitude could be an additional risk factor but acknowledged the idea remains speculative because so little data exist.
From an Embarrassing Salute to a Dystonic Storm
Not every interruption is dangerous. Earlier this year, neurosurgeons at Hannover Medical School in Germany described a 35-year-old woman whose rechargeable stimulator unexpectedly lost its charge five years after surgery for hemidystonia, a movement disorder that twists one side of the body. Her right arm rose and extended into a posture the authors compared to the Hitler salute. Recharging the device quickly brought the dystonia back under control.
For some people with dystonia, the stakes are much higher. Doctors have reported status dystonicus, a sudden and potentially life-threatening escalation of dystonic spasms, after pulse generator depletion in a patient with pantothenate kinase-associated neurodegeneration, a rare inherited brain disorder, and in a patient with primary generalized dystonia.
A 2021 systematic review in Neurologia i Neurochirurgia Polska screened 244 articles and identified 17 case reports, 11 involving Parkinson's and six involving dystonia, in which battery depletion caused rapid worsening that required urgent hospital admission. Replacing the battery was the only effective treatment in most cases. The authors concluded that depletion can be fatal and that replacement should not be postponed, warning that pandemic-era appointment delays could raise the risk.
All of this evidence comes from case reports. They show that the complication happens and how serious it can be, but they cannot say how often it occurs among the many people living with implanted stimulators.
Why Battery Life Is Hard to Predict
Batteries do not always fade on a neat schedule. When Cleveland Clinic clinicians reviewed 55 battery replacements in 38 patients, only 25.5% of cases stayed clinically well controlled right up to replacement. In 27.3% of cases, doctors had raised the voltage because symptoms were worsening, and another 25.5% had fully depleted batteries or too little reserve for any adjustment. That study involved an older non-rechargeable model.
Settings matter, too. In a University of Florida analysis of 320 battery replacements, people treated for dystonia used far higher charge density than people with Parkinson's, and higher charge density was significantly tied to shorter battery life. Rechargeable devices, like the one in the Hannover case, remove that guesswork but depend on patients or caregivers to keep them charged.
The Turku authors' bottom line is speed. They concluded that early recognition and immediate restoration of stimulation are critical to preventing severe and potentially fatal outcomes. For patients and families, a sudden return of old symptoms, or new fever, stiffness, or confusion, in someone with a stimulator is a reason to contact the implanting team or seek emergency care right away rather than wait for a routine visit.
Key Questions Answered
What is DBS withdrawal syndrome?
It is a rare emergency in people with Parkinson's disease whose deep brain stimulation stops abruptly. It can cause severe rigidity, fever, confusion, unstable blood pressure or heart rate, and signs of muscle breakdown.
What happened to the two Finnish patients?
Both went into crisis after their stimulator batteries ran out. The patient whose generator was replaced within two days recovered fully. The patient whose replacement came 14 days after symptoms began remained permanently disabled and died two and a half years later.
Why did the first case surprise doctors?
The patient had none of the three recognized risk factors: older age, Parkinson's lasting more than 15 years, and more than five years of stimulation. The authors suggested high stimulation strength may be another risk factor.
Can stimulator failure be dangerous in dystonia too?
Yes. Case reports describe status dystonicus, a sudden and potentially life-threatening worsening of dystonia, after stimulator batteries were depleted.
How common are these emergencies?
No one knows. The evidence comes from individual case reports, which show the problem happens but cannot estimate how often.
What should someone with a brain stimulator do if symptoms suddenly return?
Contact the implanting or neurology team right away, and seek emergency care for fever, severe stiffness, confusion, or trouble swallowing or breathing. A device check can confirm whether stimulation has stopped.
Published by Medicaldaily.com
