Urinary incontinence following deep brain stimulation of the globus pallidus internus: case report

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Deep brain stimulation (DBS) is a well-established therapy for patients with advanced Parkinson’s disease (PD), dystonia, and other movement disorders. In contrast to the strong positive effects that have been documented for motor symptoms, the effects of DBS on nonmotor symptoms have not been fully elucidated. Some reports suggest that stimulation of the subthalamic nucleus may improve lower urinary tract symptoms in patients with PD; however, reports of the effects of globus pallidus internus (GPi) DBS on urinary symptoms are limited. The authors present the case of a 49-year-old woman with PD who developed severe urinary incontinence after 27 months of GPi DBS. The urinary incontinence disappeared when stimulation was turned off, and reemerged after it was turned on again. After activation of a more dorsal contact in the left electrode, the patient’s urinary dynamics returned to normal.

ABBREVIATIONS DBS = deep brain stimulation; GPi = globus pallidus internus; PD = Parkinson’s disease; STN = subthalamic nucleus; UPDRS = Unified Parkinson’s Disease Rating Scale.

Article Information

Correspondence Jian-Jun Wu: Huashan Hospital, Fudan University, Shanghai, People’s Republic of China. wujianjun@fudan.edu.cn.

INCLUDE WHEN CITING Published online February 22, 2019; DOI: 10.3171/2018.11.JNS181513.

F.T.L. and L.Q.L. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.



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    The location of electrodes with respect to the GPi. The location of the cathodes is shown by co-registration of preoperative T2-weighted MR and postoperative CT images (A), a postoperative 1.5-T T1-weighted MR image (B), and a reconstructed image created using the Lead-DBS open-source toolbox (C). R = right. Figure is available in color online only.

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    Assessment of motor dysfunction (A) and motor complications (B). In the current case, both the motor abnormalities and motor complications were greatly improved after DBS treatment. MED = medication. Figure is available in color online only.

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    Urodynamics during voiding. A: GPi stimulation of 27 months’ duration induced detrusor weakness in the process of voiding. B: In the stimulation-off condition, the detrusor contraction showed a trend toward normal. C: After reprogramming, the detrusor contraction returned to normal. Pdet = detrusor pressure; s = seconds. Figure is available in color online only.



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