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.

© AANS, except where prohibited by US copyright law.



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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.


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