Rebound symptoms following battery depletion in the NIH OCD DBS cohort: Clinical and reimbursement issues

Objective Deep brain stimulation (DBS) is a promising treatment for medication refractory obsessive compulsive disorder (OCD); however, there may be neuropsychiatric symptoms from unintended battery failure. Background Previous studies indicated rebound symptoms from impulse generator (IPG) failure in Parkinson's disease, dystonia, and essential tremor. Unique to OCD is that battery failure may precipitate neuropsychiatric symptoms rather than motor symptoms. Methods Six patients with medication refractory OCD received implants as part of the previously reported National Institutional Health (NIH) DBS cohort. All available clinical data and adverse event data was reviewed. Results The average age of cohort was 42.2 years (30-59 years), and the average baseline Y-BOCS score was 33.8 (31-38). All six subjects were observed to have increased OCD symptomatology during IPG failure; however, Y-BOCS scores remained less than pretreatment range, in five subjects. One of the subjects had a Y-BOCS score greater than pretreatment during the period of IPG failure. In addition, Y-BOCS scores improved back to baseline after IPG replacement in five subjects. Other symptoms potentially related to battery failure included: suicidality (n = 1), mood disturbance (n = 2), panic attacks (n = 1), fatigue (n = 2), and a restless sensation in the arms and legs (n = 1). A small number of subjects reported no side effects associated with IPG failure because of preemptive replacement (n = 2). Conclusions This is a preliminary case series detailing the side effects resulting from IPG failure during OCD DBS. Preemptive battery replacement was an effective strategy for avoiding these issues, and timeliness in insurance reimbursement may be considered in the future. Additionally the use of rechargeable batteries may also help this issue. Clinical Trial Registration Number: NCT00057603 (C) 2012 Elsevier Inc. All rights reserved.