# Retrospective Multicenter Analysis of Withdrawal Syndrome in Parkinson’s Disease Patients After Cessation of Deep Brain Stimulation

## TL;DR

This study examines how Parkinson’s disease patients react when deep brain stimulation is stopped, finding that withdrawal symptoms are rare and usually not severe.

## Contribution

The study provides empirical evidence that DBS withdrawal syndrome is uncommon and not reliably predicted by standard clinical factors.

## Key findings

- DBS battery shutdown occurred in 13.3% of patients but did not reliably predict withdrawal syndrome.
- Severe DBS withdrawal syndrome requiring intensive care was observed in only 1.4% of patients.
- Preoperative medication dose was not associated with withdrawal risk.

## Abstract

Background: Abrupt cessation of deep brain stimulation (DBS) in Parkinson’s disease (PD), most commonly due to implantable pulse generator (IPG) battery depletion, may lead to DBS withdrawal syndrome (DBS-WDS). However, withdrawal syndrome does not occur in all patients following stimulation cessation. Methods: We retrospectively analyzed 210 PD patients treated with DBS. Patients with documented stimulation cessation were evaluated for the presence of withdrawal syndrome based on established clinical criteria. Demographic, disease-related, and treatment characteristics were assessed, and descriptive analysis was conducted on severe cases requiring intensive care. Results: DBS battery shutdown occurred in 28 patients (13.3%). Most patients did not develop withdrawal syndrome and experienced only transient motor worsening. Severe DBS-WDS requiring intensive care was rare, occurring in only three patients (1.4%). Battery shutdown alone did not predict withdrawal, nor was preoperative levodopa equivalent daily dose associated with withdrawal risk. Conclusions: DBS battery shutdown is usually not accompanied by withdrawal syndrome, and severe DBS-WDS is uncommon. Proactive battery management may help to prevent this rare but serious complication.