*Our clinical cases are drawn from the case report literature. The stories, names, and patient details are fictional, however the narratives are based on published patient cases that are available in the references.
Today we discuss the case of Elias* - the patient whose DBS malfunction was misdiagnosed as purely biological.

Elias, a 70 year-old retired teacher, who had been suffering from Parkinson’s for over 20 years, underwent surgery and was implanted with a deep brain stimulator (DBS) [1]. After the operation, Elias’ physical condition deteriorated as he became wheel-chair bound outside of home, and relied on a walking frame when home [1]. His caregiver shared that Elias would fall over frequently and that he had developed significant issues with his speech that almost hindered his ability to communicate orally completely.
Unfortunately for Elias, his worsening conditions were congruent with a worsening of his Parkinson’s condition. This meant that as his physical capacity deteriorated, Elias’ case was deemed unexceptional, and no medical professional sought an explanation outside the realm of biology. Then, about seven years after the device was first implemented, Elias’ condition changed.

Before this change, Elias had visited a medical centre to have his DBS temporarily switched-off as he was due to undergo a minor dental surgery. Five months after this contact, Elias’ caregiver called the medical team that had seen Elias to share some incredible news. Elias was able to walk independently again and his speech problems had also vastly improved [1]. Was this a medical miracle? Had the caregiver changed anything about Elias’ diet or routine? Well, the story did not end there.

In fact, Elias’ caregiver shared with the medical team that his DBS was no longer responding to the controlling device. Elias was taken into the centre once again, and the team took a look at the DBS. They confirmed that its battery had exhausted and therefore was no longer in operation. Elias’ brain had suffered, following the operation, from over-stimulation as a result of a poorly programmed DBS.
Elias's cases highlights the importance of distinguishing between device errors and disease symptoms when caring for patients with implanted digital technologies. Given that medical devices are usually sited within the anatomical area of diseased tissue, (e.g. DBS in Parkinson's, Pacemakers in Heart Failure), their malfunctions may mimic the classic symptoms of the disease they are prescribed to treat [1-3]. Thus, clinicians face the diagnostic challenge of untangling these similarly presenting complaints, in order to treat the true root cause.
This case study has attempted to demonstrate that new technologies, and in particular medical technologies, remain just that: novel [1-3]. This means that any positive short-term results may obfuscate negative long-term impacts. For many patients, clinicians may not have all of the evidence, knowledge, or training to comfortably assure the wellbeing of patients. Elias’ case demonstrates that physical symptoms, such as mobility and speech distribution, are at risk of being attributed to traditional biological sources, until the medical professionals are educated on the implications of technological parts in biological bodies.
Learning Points
Device pathology vs. disease progression: Dysfunctional devices located in the anatomical region of disease may present as symptoms consistent with the underlying illness, leading to clinical confusion and misdiagnosis.
Long term follow up for digitally-dependent patients: Post-operative device checks are essential for identifying and intervening when devices cause harm, however follow up practices appear to vary within and between countries.
Digital health histories: When monitoring patients with progressive diseases, clinicians should not only evaluate the therapeutic effects of medications but also any medical devices that they may be using for symptom/disease management.
References
[1] Sommer M, Stiksrud EM, von Eckardstein K, Rohde V, Paulus W. When battery exhaustion lets the lame walk: a case report on the importance of long-term stimulator monitoring in deep brain stimulation. BMC Neurol. 2015;19(15):113
[2] Lahtinen, T., Costin, A. (2023). Linking Computers to the Brain: Overview of Cybersecurity Threats and Possible Solutions. In: Shishkov, B. (eds) Business Modeling and Software Design. BMSD 2023. Lecture Notes in Business Information Processing, vol 483. Springer, Cham. https://doi.org/10.1007/978-3-031-36757-1_29
[3] Markosian, C., Taruvai, V.S. & Mammis, A. Neuromodulatory hacking: a review of the technology and security risks of spinal cord stimulation. Acta Neurochir 162, 3213–3219 (2020). https://doi.org/10.1007/s00701-020-04592-3
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