We report 5 of 75 (6.6%) patients with Parkinson’s disease (PD) submitted to subthalamic nucleus deep brain stimulation (STN-DBS) who developed transient disabling dyskinesias immediately after surgery. Dyskinesias persisted despite levodopa withdrawal, cessation or reduction of stimulation, and resolved spontaneously in a maximum period of 12 weeks without the need to change stimulation active contact. Compared to the rest of our PD patients submitted to STN-DBS, the dyskinesia group needed a lower levodopa-equivalent daily dosage (LEDD) over the time of follow-up. A microlesion in the STN, probably concealed in cerebral MRI by the electrode-related artifact, could have been involved in the etiopathology of our patients’ symptoms. The presence of transient disabling dyskinesia in PD patients immediately after STN-DBS might be a predictor of good outcome as measured by a decrease in the LEDD needed.

Keywords:
Parkinson’s disease, Deep brain stimulation, Subthalamic nucleus, Disabling dyskinesia
1.
Burchiel KJ, Anderson VC, Favre J, Hammerstad JP: Comparison of pallidal and subthalamic nucleus deep brain stimulation for advanced Parkinson’s disease: results of a randomized, blinded pilot study. Neurosurgery 1999;45:1375–1382.
2.
Hamani C, Richter E, Schwalb JM, Lozano AM: Bilateral subthalamic nucleus stimulation for Parkinson’s disease: a systematic review of the clinical literature. Neurosurgery 2005;56:1313–1321.
3.
Kumar R, Lozano AM, Kim YJ, Hutchison WD, Sime E, Halket E, Lang AE: Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson’s disease. Neurology 1998;51:850–855.
4.
Limousin P, Pollak P, Benazzouz A, Hoffmann D, Le Bas JF, Broussolle E, Perret JE, Benabid AL: Effect of parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet 1995;345:91–95.
5.
Valldeoriola F, Pilleri M, Tolosa E, Molinuevo JL, Rumia J, Ferrer E: Bilateral subthalamic stimulation monotherapy in advanced Parkinson’s disease: long-term follow-up of patients. Mov Disord 2002;17:125–132.
6.
Fraix V, Pollak P, Van Blercom N, Xie J, Krack P, Koudsie A, Benabid AL: Effect of subthalamic nucleus stimulation on levodopa-induced dyskinesia in Parkinson’s disease. Neurology 2001;57:S60–S62.
7.
Houeto JL, Damier P, Bejjani PB, Staedler C, Bonnet AM, Arnulf I, Pidoux B, Dormont D, Cornu P, Agid Y: Subthalamic stimulation in Parkinson disease: a multidisciplinary approach. Arch Neurol 2000;57:461–465.
8.
Martinez-Martin P, Valldeoriola F, Tolosa E, Pilleri M, Molinuevo JL, Rumia J, Ferrer E: Bilateral subthalamic nucleus stimulation and quality of life in advanced Parkinson’s disease. Mov Disord 2002;17:372–377.
9.
Kleiner-Fisman G, Fisman DN, Sime E, Saint-Cyr JA, Lozano AM, Lang AE: Long-term follow-up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease. J Neurosurg 2003;99:489–495.
10.
Herzog J, Volkmann J, Krack P, Kopper F, Potter M, Lorenz D, Steinbach M, Klebe S, Hamel W, Schrader B, Weinert D, Muller D, Mehdorn HM, Deuschl G: Two-year follow-up of subthalamic deep brain stimulation in Parkinson’s disease. Mov Disord 2003;18:1332–1337.
11.
Volkmann J, Allert N, Voges J, Weiss PH, Freund HJ, Sturm V: Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD. Neurology 2001;56:548–551.
12.
Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, Koudsie A, Limousin PD, Benazzouz A, LeBas JF, Benabid AL, Pollak P: Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 2003;349:1925–1934.
13.
Alterman RL, Shils JL, Gudesblatt M, Tagliati M: Immediate and sustained relief of levodopa-induced dyskinesias after dorsal relocation of a deep brain stimulation lead. Case report. Neurosurg Focus 2004;17:E6.
14.
Herzog J, Pinsker M, Wasner M, Steigerwald F, Wailke S, Deuschl G, Volkmann J: Stimulation of subthalamic fibre tracts reduces dyskinesias in STN-DBS. Mov Disord 2007;22:679–684.
15.
Volkmann J, Herzog J, Kopper F, Deuschl G: Introduction to the programming of deep brain stimulators. Mov Disord 2002;17 (suppl 3):S181–S187.
16.
Alvarez L, Macias R, Lopez G, Alvarez E, Pavon N, Rodriguez-Oroz MC, Juncos JL, Maragoto C, Guridi J, Litvan I, Tolosa ES, Koller W, Vitek J, DeLong MR, Obeso JA: Bilateral subthalamotomy in Parkinson’s disease: initial and long-term response. Brain 2005;128:570–583.
17.
Martin JP: Hemichorea (hemiballismus) without lesions in the corpus luysii. Brain 1957;80:1–10.
18.
Shannon KM: Hemiballismus. Clin Neuropharmacol 1990;13:413–425.
19.
Vidakovic A, Dragasevic N, Kostic VS: Hemiballism: report of 25 cases. J Neurol Neurosurg Psychiatry 1994;57:945–949.
20.
Chung SJ, Im JH, Lee MC, Kim JS: Hemichorea after stroke: clinical-radiological correlation. J Neurol 2004;251:725–729.
21.
Basto MA, Linhares P, Sousa AN, Rosas MJ, Garrett C, Mendes A, Fonseca R, Amaral C, Vaz R: Imaging in Parkinson disease surgery. Acta Med Port 2003;16:135–140.
22.
Starr PA, Christine CW, Theodosopoulos PV, Lindsey N, Byrd D, Mosley A, Marks WJ Jr: Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations. J Neurosurg 2002;97:370–387.
23.
Saint-Cyr JA, Hoque T, Pereira LC, Dostrovsky JO, Hutchison WD, Mikulis DJ, Abosch A, Sime E, Lang AE, Lozano AM: Localization of clinically effective stimulating electrodes in the human subthalamic nucleus on magnetic resonance imaging. J Neurosurg 2002;97:1152–1166.
24.
Wenzelburger R, Zhang BR, Poepping M, Schrader B, Muller D, Kopper F, Fietzek U, Mehdorn HM, Deuschl G, Krack P: Dyskinesias and grip control in Parkinson’s disease are normalized by chronic stimulation of the subthalamic nucleus. Ann Neurol 2002;52:240–243.
25.
Deep-Brain Stimulation for Parkinson’s Disease Study Group: Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease. N Engl J Med 2001;345:956–963.
26.
Pollo C, Villemure JG, Vingerhoets F, Ghika J, Maeder P, Meuli R: Magnetic resonance artifact induced by the electrode Activa 3389: an in vitro and in vivo study. Acta Neurochir (Wien) 2004;146:161–164.
27.
Crossman AR: Primate models of dyskinesia: the experimental approach to the study of basal ganglia-related involuntary movement disorders. Neuroscience 1987;21:1–40.
28.
Hamada I, DeLong MR: Excitotoxic acid lesions of the primate subthalamic nucleus result in transient dyskinesias of the contralateral limbs. J Neurophysiol 1992;68:1850–1858.
29.
Guridi J, Obeso JA: The subthalamic nucleus, hemiballismus and parkinson’s disease: reappraisal of a neurosurgical dogma. Brain 2001;124:5–19.
30.
Houeto JL, Welter ML, Bejjani PB, Tezenas du Montcel S, Bonnet AM, Mesnage V, Navarro S, Pidoux B, Dormont D, Cornu P, Agid Y: Subthalamic stimulation in parkinson disease: intraoperative predictive factors. Arch Neurol 2003;60:690–694.
31.
Shin M, Lefaucheur JP, Penholate MF, Brugieres P, Gurruchaga JM, Nguyen JP: Subthalamic nucleus stimulation in Parkinson’s disease: postoperative CT-MRI fusion images confirm accuracy of electrode placement using intraoperative multi-unit recording. Neurophysiol Clin 2007;37:457– 466.
32.
Winkler D, Tittgemeyer M, Schwarz J, Preul C, Strecker K, Meixensberger J: The first evaluation of brain shift during functional neurosurgery by deformation field analysis. J Neurol Neurosurg Psychiatry 2005;76:1161–1163.
33.
Rezai AR, Phillips M, Baker KB, Sharan AD, Nyenhuis J, Tkach J, Henderson J, Shellock FG: Neurostimulation system used for deep brain stimulation (DBS): MR safety issues and implications of failing to follow safety recommendations. Invest Radiol 2004;39:300–303.
34.
Henderson JM, Tkach J, Phillips M, Baker K, Shellock FG, Rezai AR: Permanent neurological deficit related to magnetic resonance imaging in a patient with implanted deep brain stimulation electrodes for Parkinson’s disease: case report. Neurosurgery 2005;57:E1063.
35.
Kleiner-Fisman G, Herzog J, Fisman DN, Tamma F, Lyons KE, Pahwa R, Lang AE, Deuschl G: Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord 2006;21(suppl 14):S290–S304.
© 2008 S. Karger AG, Basel
2008
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.