Deactivation of One Subthalamic Nucleus Deep Brain Stimulation Device to Address Brittle Ipsilateral Dyskinesia in a Patient With Tremor-Dominant Parkinson Disease
A 78-year-old right-handed woman with a 10-year history of tremor-dominant Parkinson disease (PD) was recommended for bilateral deep brain stimulation (DBS) in the subthalamic nucleus (STN). The patient was implanted with bilateral omnidirectional STN DBS electrodes after intraoperative microelectrode recordings and intraoperative test stimulation. Immediately after implantation, the motor symptoms improved considerably, but 3 to 4 weeks later, a debilitating left-sided resting tremor re-emerged. Personalized programming at the right STN ameliorated the tremor, while painful dyskinesia and hemiballism of the ipsilateral right side of the body developed subsequently over the next few days. Adapting the stimulation parameters and the dopaminergic medication improved these symptoms only marginally. After turning off the left STN electrode, the dyskinesia and hemiballism disappeared completely. In the following weeks, the amperage of the right STN electrode was increased gradually to control the left-sided resting tremor. This was possible without the development of ipsilateral hyperkinesia. During the off phases of stimulation, a considerable direct improvement of hyperkinesia was noted, and the decision to turn off the left STN electrode was ultimately made.