Transient Disabling Dyskinesias: A Predictor of Good Outcome in Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease

Abstract

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.

Globus Pallidus Internus Deep Brain Stimulation as Rescue Therapy for Refractory Dyskinesias following Effective Subthalamic Nucleus Stimulation

“…Dyskinesias are a recognised complication following STN DBS [14,15,16,17,18]. The phenomenology is similar to lesion-induced [15] and levodopa-induced [21] dyskinesias, although in our experience the distribution of post-operative dyskinesias can differ from pre-operative levodopa-induced dyskinesias in the same patient.…”

“…The phenomenology is similar to lesion-induced [15] and levodopa-induced [21] dyskinesias, although in our experience the distribution of post-operative dyskinesias can differ from pre-operative levodopa-induced dyskinesias in the same patient. Whilst post-operative or stimulation-induced dyskinesias generally habituate [14,15,16,17,18], prolonged hyperkinesias that last weeks or months can occur. Treatment options include cessation or rapid reduction of anti-parkinsonian medications, or alternative stimulation configurations [16,17].…”

“…Whilst post-operative or stimulation-induced dyskinesias generally habituate [14,15,16,17,18], prolonged hyperkinesias that last weeks or months can occur. Treatment options include cessation or rapid reduction of anti-parkinsonian medications, or alternative stimulation configurations [16,17]. Stimulation of a more rostral contact can suppress dyskinesias.…”

“…Dyskinesias can occur after STN DBS, particularly in the early post-operative period [14,15,16,17,18], but usually resolve spontaneously, or with medication or stimulation adjustment. Here, we describe 2 rare cases where dyskinesias developed following effective STN DBS that were refractory to standard treatment.…”

Post-Operative Management of Parkinson Patients with Deep Brain Stimulation

“…Stimulation-induced dyskinesias are another important motor phenomenon to evaluate DBS efficacy. Stimulation-induced dyskinesias have been demonstrated to be a predictor of good long-term outcome of DBS (Gago et al, 2008). Most importantly, dyskinesias often develop or increase in severity with a latency of minutes to hours so that careful www.intechopen.com observation of patients after initiation of DBS is recommended.…”