Dorsal GPi/GPe Stimulation Induced Dyskinesia in a Patient with Parkinson's Disease

• Published in: Tremor and other hyperkinetic movements (New York, N.Y.) Vol. 9; pp. 1 - 5
• Main Authors: Elkouzi, Ahmad, Tsuboi, Takashi, Burns, Matthew R, Eisinger, Robert S, Patel, Amar, Deeb, Wissam
• Format: Journal Article
• Language: English
• Published: Columbia University Libraries/Information Services 06.09.2019; Ubiquity Press
• Subjects: Deep Brain Stimulation (DBS); Deep Brain Stimulation Case Files; Globus Pallidus Interna (GPi); Parkinson’s Disease (PD); Stimulation Induced Dyskinesia (SID)
• ISSN: 2160-8288
• DOI: 10.7916/tohm.v0.685

Clinical vignetteA 68-year-old man with Parkinson's disease (PD) had bilateral GPi DBS placed for management of his motor fluctuations. He developed stimulation-induced dyskinesia (SID) with left dorsal GPi stimulation. Clinical dilemmaWhat do we know about SID in PD patients with GPi DBS? What are the potential strategies used to maximize the DBS therapeutic benefit and minimize the side effects of stimulation? Clinical solutionAvoiding the contact implicated in SID and programming more ventral contacts, using lower voltage, frequency and pulse width and programming in bipolar configuration all appear to help minimize the SID and provide appropriate symptomatic motor control. Gap in knowledgeLittle is known about SID in patients with PD who had GPi DBS therapy. More studies using volume of tissue activated and diffusion tensor imaging MRI are needed to localize specific tracts in or around the GPi that may be implicated in SID.