Impedance Problems and Their Causes—A Single-Center Analysis of 601 Patients with De Novo Deep Brain Stimulation

<b>Background/Objectives</b>: Patients with deep brain stimulation (DBS) require regular follow-up. When a sudden loss of therapeutic effect occurs, impedance abnormalities are often the underlying cause. If reprogramming cannot restore clinical benefit, revision surgery may be necessary to replace defective hardware. Since all three major manufacturers are used at our center, we analyzed our patient cohort to determine the incidence and causes of impedance abnormalities. <b>Methods</b>: All 601 patients who underwent de novo DBS implantation in Hamm between 2009 and 2025 were evaluated for impedance abnormalities. In cases requiring revision surgery, the specific cause was identified. The manufacturer, electrodes, and contacts involved were systematically analyzed. <b>Results</b>: A total of 25 of 601 patients required revision surgery. Revision rates were 2.67% in patients with Parkinson's disease, 6.19% in those with a tremor, and 5.71% in those with dystonia. Across manufacturers, 7.6% of patients with a Medtronic system required revision surgery, compared with 3.4% of patients with an Abbott system and no patients with a Boston Scientific system. The primary causes of revision were electrode-related problems (19/25), followed by extension defects (6/25), connector issues (4/25), and, in one case, a generator defect (1/25). <b>Conclusions</b>: Only 4.16% of patients required revision surgery due to impedance abnormalities. Patients with a tremor and non-segmented electrodes showed a higher incidence than those with Parkinson's disease or dystonia. Predominantly older Medtronic systems had the highest revision rate, whereas no Boston Scientific systems required revision. In most cases, the electrodes were the primary source of impedance abnormalities. A total of 52% of revisions were performed within two years and 92% were performed within six years of implantation.