Resolving dyskinesias at sustained anti-OCD efficacy by steering of DBS away from the anteromedial STN to the mesencephalic ventral tegmentum – case report

Abstract

Here we describe therapeutic results in a female patient who underwent bilateral slMFB DBS for OCD. During a 35-month long course of stimulation, she suffered from stimulation-induced dyskinesia of her right leg which we interpreted as co-stimulation of the adjacent anteromedial subthalamic nucleus (amSTN). After reprogramming to steer the stimulation away from the amSTN medial into the direction of the mesencephalic ventral tegmentum (MVT which contains the ventral tegmental area, VTA), the dyskinesias disappeared. Remarkably, anti-OCD efficacy in the presented patient was preserved and achieved with a bilateral stimulation which by our imaging study fully avoided the amSTN.

Directional electrodes in deep brain stimulation: Results of a survey by the European Association of Neurosurgical Societies (EANS)

“…Most experts believed that mainly patients with well-established indications, such as PD, tremor and dystonia would benefit most from directionality. This is very much in line with the literature so far, where most published studies are on PD and tremor ( Bruno et al, 2021 ; Shao et al, 2020 ; Rebelo et al, 2018 ; Schnitzler et al, 2022 ), with only a small number of case reports or small case series on dystonia, pain or psychiatric diseases ( Abel et al, 2021 ; Asahi et al, 2021 ; Krüger et al, 2021c ; Coenen et al, 2022 ; Lopez et al, 2021 ), and no studies on depression or epilepsy.…”

Identification and Management of Persistent Stimulation-Induced Dyskinesia Associated with STN DBS: The See-Saw Dilemma

“…Though the study methods were suboptimal in the application of STN segmentation and relied on stereotactic coordinates, they do raise the important question of influence of the underlying disorder on the SID [4]. Supportive of this notion is an example of STN DBS in obsessive compulsive disorder (OCD) which revealed a more anterior location of neuromodulation within STN, which was observed to trigger hyperkinesia [5,6]. Finally, STN related SID was the most common "limiting side effect" in a prospective study of isolated dystonia DBS.…”