Position-Dependent Dysfunction Of Deep Brain Stimulation In Tourette Syndrome: Diagnostic Clues

Background: Detection of defective deep brain stimulation (DBS) contacts/electrodes is sometimes challenging.Case Report: We report a patient with Tourette syndrome (TS), who presented with abrupt tic increase and mild generalized headache 9 years after DBS implantation. On the suspicion of a hardware defect, a fracture of the DBS electrode and extension lead was ruled out by radiography and standard implantable pulse generator readouts. Further investigation revealed position-dependent modifiable therapeutic impedances, suggesting an impaired contact of the extension lead/ adaptor. After replacement normal impedances were recorded, and the patient fully recovered.Discussion: In DBS dysfunction with inconspicuous hardware check, position-dependent defects might be suspected.