When brain devices go wrong: a patient with a malfunctioning deep brain stimulator (DBS) presents to the emergency department

Abstract

A man in his 50s attended the emergency department with an acute deterioration in his Parkinson’s symptoms, presenting with limb rigidity, widespread tremor, choreiform dyskinesia, dysarthria, intense sadness and a severe occipital headache. After excluding common differentials for sudden-onset parkinsonism (eg, infection, medication change), an error on the patient’s deep brain stimulator was noted. The patient’s symptoms only resolved once he was transferred to the specialist centre so that the programmer could reset the device settings. Due to COVID-19-related bed pressures on the ward, there was a delay in the patient receiving specialist attention—highlighting the need for non-specialist training in the emergency management of device errors.

Simulation-based research for digital health pathologies: A multi-site mixed-methods study

“…In addition, there is a lack of research on the effective symptomatic management of physiological issues associated with technological complaints, for example, are pharmacological interventions as effective for pain stemming from faults in implantables (e.g. a malfunctioning deep brain stimulator [DBS] 40 ). The growing research that explores the benefits of new medical devices needs to be paired with an equally deep investigation into their potential long-term healthcare implications, the novel pathological pathways that emerge with new implants and the treatments that are effective when they go wrong.…”

“…Table 1 provides a summary of the four clinical scenarios that were designed based on existing literature and published case reports. 3 , 40 Detailed instructions for actors and sim facilitators were provided for each scenario to ensure consistency across sites. We focused on four different themes of technological failures (full details of scenarios are published in Appendix 1 for reuse): Scenario 1: Software failure in a medical device.…”

Simulation based research for digital health pathologies: a multi-site mixed-methods study

“…These guidelines may introduce generic measures such as removing potentially 'listening' devices from a consultation room and the use of Faraday bags if there are concerns of geolocation tracking. (40). The growing research that explores the benefits of new medical devices needs to be paired with an equally deep investigation into their potential long-term healthcare implications, the new pathological pathways that emerge with new implants, and the treatments that are effective when they go wrong.…”

21st century medicine and emerging biotechnological syndromes: a cross-disciplinary systematic review of novel patient presentations in the age of technology

“…The screens we are staring into daily are reshaping our eyes [1]; our backs bend into our devices stretching our spines into new postures [2]; our minds twist to adapt new modes of information processing [3]; all the while our tapping fingers are reshaping our tendons and joints [4,5]. The implantation and ingestion of digital technologies into the body has further expanded the remit of possible technology-related bodily phenomena [6][7][8][9][10][11]. Our psychology and physicality are constantly in flux, moulded by our shifting environment that is evermore defined by digitisation as we carry out dual online and offline lives.…”

“…Here we argue that the landscape of healthcare biotechnology is now so complex that digital complaints can no longer be managed as an offshoot of an existing clinical domain. We see this need manifesting across specialties-psychiatrists are responding to unusual psychological sequelae resulting from digital technologies (e.g., digital hoarding [14]), ophthalmologists are observing advanced rates myopia related to screen-use [1], and neurologists are witnessing new neuropsychiatric manifestations from errors in implanted Deep Brain Stimulators (DBS) [8,[15][16][17][18][19]. Though these presentations may seem heterogeneous, the underlying mechanisms are often shared and require examination through the lens of their similarities e.g., software bugs in pacemakers may also occur in spinal stimulators.…”