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

Restricted access

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.

Headings

Figures

  • View in gallery

    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.

  • View in gallery

    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.

  • View in gallery

    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.

References

1

Herzog JWeiss PHAssmus AWefer BSeif CBraun PM: Improved sensory gating of urinary bladder afferents in Parkinson’s disease following subthalamic stimulation. Brain 131:1321452008

2

Horn AKühn AA: Lead-DBS: a toolbox for deep brain stimulation electrode localizations and visualizations. Neuroimage 107:1271352015

3

Kessler TMBurkhard FCZ’Brun SStibal AStuder UEHess CW: Effect of thalamic deep brain stimulation on lower urinary tract function. Eur Urol 53:6076122008

4

Mock SOsborn DJBrown ETStuart Reynolds WTurchan MPallavaram S: The impact of pallidal and subthalamic deep brain stimulation on urologic function in Parkinson’s disease. Neuromodulation 19:7177232016

5

Mordasini LKessler TMKiss BSchüpbach MPollo CKaelin-Lang A: Bladder function in patients with dystonia undergoing deep brain stimulation. Parkinsonism Relat Disord 20:101510172014

6

Ni ZKim SJPhielipp NGhosh SUdupa KGunraj CA: Pallidal deep brain stimulation modulates cortical excitability and plasticity. Ann Neurol 83:3523622018

7

Palma JAKaufmann H: Treatment of autonomic dysfunction in Parkinson disease and other synucleinopathies. Mov Disord 33:3723902018

8

Roy HAAziz TZFitzgerald JJGreen AL: Beta oscillations and urinary voiding in Parkinson disease. Neurology 90:e1530e15342018

9

Sakakibara RPanicker JFinazzi-Agro EIacovelli VBruschini H: A guideline for the management of bladder dysfunction in Parkinson’s disease and other gait disorders. Neurourol Urodyn 35:5515632016

10

Sakakibara RTateno FYamamoto TUchiyama TYamanishi T: Urological dysfunction in synucleinopathies: epidemiology, pathophysiology and management. Clin Auton Res 28:831012018

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 200 200 200
Full Text Views 50 50 50
PDF Downloads 23 23 23
EPUB Downloads 0 0 0

PubMed

Google Scholar