Stimulation-induced parkinsonism after posteroventral deep brain stimulation of the globus pallidus internus for craniocervical dystonia

Case report

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The authors report on a patient with craniocervical dystonia who was treated with bilateral GPi stimulation, with excellent improvement in dystonia but at the cost of stimulation-induced, reversible parkinsonism. Stimulation through ventral contacts resulted in maximal relief of craniocervical dystonia but induced considerable hypophonia, bradykinesia, rigidity, freezing, and impaired postural reflexes. Stimulation through dorsal contacts alleviated parkinsonism, but resulted in the return of dystonia. No stimulation parameters could alleviate the dystonia without inducing parkinsonism over the course of his 4-year follow-up.

Abbreviations used in this paper: DBS = deep brain stimulation; ; GPi = globus pallidus internus; ; IPG = implantable pulse generator; ; PD = Parkinson disease..

Article Information

Address correspondence to: Leo Verhagen Metman, M.D., Ph.D., Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, Illinois 60612. email:lverhage@rush.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Axial T2-weighted MR imaging studies demonstrating the DBS electrode location in the GPi. Arrows indicate distance from midline in millimeters.

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    Sample of handwriting showing micrographia when stimulation is ON and normal-sized writing when stimulation is OFF.

References

  • 1

    Bejjani BDamier PArnulf IBonnet AMVidailhet MDormont D: : Pallidal stimulation for Parkinson's disease: two targets?. . Neurology 49::156415691997

  • 2

    Burke REFahn SMarsden CDBressman SBMoskowitz CFriedman J: : Validity and reliability of a rating scale for the primary torsion dystonias. . Neurology 35::73771985

  • 3

    Comella CLLeurgans SWuu JStebbins GTChmura T: : Dystonia Study Group: : Rating scales for dystonia: a multicenter assessment. . Mov Disord 18::3033122003

  • 4

    Krack PPollak PLimousin PHoffmann DBenazzouz ALe Bas : : Opposite motor effects of pallidal stimulation in Parkinson's disease. . Ann Neurol 43::1801921998

  • 5

    Kupsch ABenecke RMüller JTrottenberg TSchneider GHPoewe W: : Pallidal deep-brain stimulation in primary generalized or segmental dystonia. . N Engl J Med 355::197819902006

  • 6

    Mazzone PLozano AStanzione PGalati SScarnati EPeppe A: : Implantation of human pedunculopontine nucleus: a safe and clinically relevant target in Parkinson's disease. . Neuroreport 16::187718812005

  • 7

    Moro ELang AEStrafella APPoon YYArango PMDagher A: : Bilateral globus pallidus stimulation for Huntington's disease. . Ann Neurol 56::2902942004

  • 8

    Nandi DLiu XWinter JLAziz TZStein JF: : Deep brain stimulation of the peduncuplopontine region in the normal non–human primate. . J Clin Neurosci 9::1701742002

  • 9

    Ostrem JLMarks WJVolz MMHeath SLStarr PA: : Pallidal deep brain stimulation in patients with cranial-cervical dystonia (Meige syndrome). . Mov Disord 22::188518912007

  • 10

    Shink ESidibe MSmith Y: : Efferent connections of the internal globus pallidus in the squirrel monkey: II. Topography and synaptic organization of pallidal efferents to the pedunculopontine nucleus. . J Comp Neurol 382::3483631997

  • 11

    Tisch SZrinzo LLimousin PBhatia KPQuinn NAshkan K: : The effect of electrode contact localization on clinical efficacy of pallidal deep brain stimulation in primary generalized dystonia. . J Neurol Neurosurg Psychiatry 78::131413192007

  • 12

    Vidailhet MVercueil LHoueto JLKrystkowiak PBenabid ALCornu P: : Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia. . N Engl J Med 352::4594672005

  • 13

    Watson NKVerhagen ML: : Reversible parkinsonism as a complication of pallidal stimulation for dystonia. . Mov Disord 21::15 SupplS6762006. . (Abstract)

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