New-onset seizures following cochlear implantation reprogramming – A case report

Background Cochlear implant (CI) soft failures are relatively rare and have wide-ranging presentations. We present a CI soft failure case that manifested with facial pain and auditory clicking which progressed to severe spasmodic episodes consistent with psychogenic non-epileptiform seizures (PNES). Case description A 28-year-old male underwent CI processor replacement and shortly afterward developed intractable adverse facial and auditory symptoms consistent with soft failure followed immediately by seizure-like episodes. These symptoms persisted and progressively worsened despite deactivation of the implant and failed to respond to anti-epileptic medications. Neurology workup, including EEG, demonstrated waveforms inconsistent with epilepsy but instead favored a diagnosis of PNES. He underwent device explantation with complete resolution of his facial and auditory symptoms as well as his non-epileptiform seizures. Conclusions Although cochlear implantation is generally well tolerated without complications, a small subset of patients can develop symptoms of soft failure and require explantation. This represents the only published case of PNES as a consequence of CI soft failure. Although the underlying physiology of this presentation is not well understood, there was complete resolution of symptoms following explantation.