Infected internal pulse generator: Treatment without removal

BACKGROUND: One of the rare but devastating complications of deep brain stimulation (DBS) is internal pulse generator (IPG) infection. In the majority of the cases, removal of the device is required, despite appropriate antibiotic therapy. We demonstrate that eradication of an IPG infection is feasible without removal of the IPG device. CASE DESCRIPTION: This article reports the authors’ experience on two patients who underwent DBS for advanced Parkinson's disease (PD) and, subsequently, suffered from infection and skin breakdown over the IPG. The patients were treated with antibiotic therapy, surgical revision of the wound, intraoperative disinfection of the IPG and relocation of the subcutaneous pocket. In both cases, the infection was eradicated and DBS therapy was continued uninterrupted. CONCLUSION: Although not generally recommended, DBS IPG may be salvaged in selected cases of superficial device infection. Our experience suggests that it is possible to treat the infection without removing the device. Such an approach decreases the morbidity, duration of hospital stay and health care costs.