Deep Brain Stimulator (DBS) or Other Neurostimulation Device
The device on the right chest of a Parkinson's patient is most likely a deep brain stimulator (DBS) pulse generator, which is the battery-powered component of a neurostimulation system used to treat motor symptoms of Parkinson's disease 1.
Device Identification
The pulse generator (also called an implantable pulse generator or IPG) is implanted in a subcutaneous pocket in the chest region, typically in the infrapectoral or subclavicular area 1, 2. This device connects via extension leads to electrodes implanted in specific brain targets (commonly the subthalamic nucleus or globus pallidus interna) to deliver continuous electrical stimulation.
Key Distinguishing Features
On physical examination, you can:
- Palpate a firm, rectangular device under the skin in the chest area
- Look for surgical scars in the chest region and on the scalp
- Check for visible bulging where the device sits subcutaneously
On chest X-ray, the DBS system appears as:
- A pulse generator in the chest (rectangular radiopaque device)
- Extension leads running from the chest up toward the neck
- Brain electrodes visible on skull films (though not typically seen on standard chest X-ray)
This is distinctly different from cardiac devices (pacemakers/ICDs), which would show leads extending into the heart chambers with visible shocking coils in the case of ICDs 1.
Clinical Significance for Parkinson's Disease
DBS is indicated for Parkinson's patients with:
- Motor fluctuations inadequately controlled by medications
- Medication-refractory tremor
- Disabling dyskinesias
- Significant motor complications despite optimized medical therapy 3
Critical Management Considerations
If this patient requires surgery or procedures:
Identify the device manufacturer and model - obtain the patient's device identification card or contact their neurology/DBS clinic 1
Turn off the device before procedures using electrocautery - monopolar electrocautery can cause electromagnetic interference leading to device malfunction or dangerous heating of brain tissue around the electrodes 1, 2
Use bipolar electrocautery or ultrasonic scalpel when possible to minimize electromagnetic interference 1, 4
Be aware that turning off the device may cause severe symptom recurrence - deactivation in a Parkinson's patient can result in severe motor symptoms including rigidity, tremor, and bradykinesia within minutes to hours 1
Device must be checked and reactivated postoperatively by qualified personnel 1
Common Pitfalls
Device malfunction or battery depletion can precipitate parkinsonism-hyperpyrexia syndrome (PHS), a potentially fatal condition mimicking neuroleptic malignant syndrome with fever, rigidity, altered mental status, and autonomic instability 5. This medical emergency requires immediate recognition and treatment.
Do not confuse with cardiac devices - while both are implanted in the chest, cardiac rhythm devices have leads extending into the heart, whereas DBS leads extend toward the brain. The clinical context (Parkinson's disease) strongly suggests a neurostimulator rather than a cardiac device.