Managing Lead Fractures in Deep Brain Stimulation for Movement Disorders: A Decade-Long Case Series from a National Neurosurgical Centre

Abstract

Background: Deep brain stimulation (DBS) is an effective treatment for movement disorders, but its long-term efficacy may be undermined by hardware complications such as lead fractures. These complications increase healthcare costs and necessitate surgical revisions. The frequency, timing, and clinical factors associated with lead fractures remain poorly understood. Objective: This study aimed to determine the incidence, timing, and clinical factors associated with lead fractures in a large cohort of DBS patients over a 10-year period. Methods: This retrospective study analyzed data from 325 patients who underwent bilateral DBS implantation at the National Centre for Neurosurgery from 2013 to 2023. The analysis specifically focused on 17 patients who experienced lead fractures during the long-term follow-up period. Results: Among the 325 patients, lead fractures were identified in 17 patients (5.23%), affecting 18 electrodes. The majority of cases involved patients with Parkinson's disease (76.5%) or dystonia (23.5%), with an average age of 59.17 ± 8.77 years. Nearly all patients with lead fractures had a history of trauma. Additionally, two cases were associated with active engagement in sports, particularly activities involving movements like pulling up on a horizontal bar, while Twiddler's Syndrome was identified in two other cases. All electrode fractures required surgical revision. Conclusions: Lead fractures, while rare, remain a significant complication in DBS systems. Precise surgical techniques, early detection, and advancements in DBS hardware design may help to mitigate this risk. Future innovations, such as durable leads or wireless systems, may improve long-term outcomes in DBS therapy for movement disorders.

Keywords: deep brain stimulation; extension failure; hardware-related complication; lead fractures.

Figure 1

Chest X-ray showing IPG and coiling of extension wires.

Figure 2

Skull X-ray illustrating intact DBS leads (A). Chest X-ray showing the lead fracture with connection located in subclavicular region (B).

Figure 3

Intracranial extension wire fracture (A). Post-operative frontal CT after intracranial electrode replacement (B).

Figure 4

Skull (A) X-ray showing any deformities of the leads. Chest (B) X-ray showing the reversed position of the extensions at the junction connecting to the IPG. Intraoperative view of the lead fracture at the point of connection between extension and IPG (C).