Research Insights

Adverse effects of subthamalmic nucleus DBS in a patient with multiple system atrophy

Neurology

Tarsy D, Apetauerova D, Ryan P, Norregaard T Adverse effects of subthamalmic nucleus DBS in a patient with multiple system atrophy Neurology, 2003 Jul 22;61(2):247-9

These authors discuss a case of a 59 year old woman that had adverse effects after DBS-STN. Notably they discuss that DBS-STN can be a very efficacious treatment for properly selected patients with PD. They also list the main successes for patients after DBS-STN. They also note that DBS-STN research does not address DBS-STN in atypical Parkinson syndromes (e.g. Multiple Systems Atrophy, MSA). Due to the lack of research in this area they chose to submit their results for publication discussing that issue. Initially, the patient presented with many of the motor symptoms commonly seen in PD. She responded to levodopa-carbidopa treatment for a few years but her symptoms worsened over the next 4 years. She had no response to Amantadine, pergolide (Permax), or ropinirole (Requip), but continued levodopa-carbidopa and pergolide. She underwent DBS-STN 7 years after initial symptom presentation although she also had clinical signs of MSA. Prior to surgery she was informed that she had atypical Parkinson’s and that the typical reductions in symptoms from DBS-STN could not be guaranteed in her case. Her upper extremity bradykinesia improved but she continued to have many of her other symptoms (e.g. speech, gait, postural stability). She initially had reduced levodopa-carbidopa after surgery but within 9 months of surgery was back to presurgical levels. After 9 months she developed many adverse effects and in some areas did better when her stimulator was turned off, even after extensive reprogramming and medication adjustments. MRI at 10 months showed correct placement in the STN. Due to continued worsening her stimulators were turned off 11 months postsurgery. It is notable that she had residual gait and balance difficulties, while many of her other symptoms improved (e.g. swallowing, drooling, aspiration). The authors discuss MSA as compared to PD as well as other cases of MSA that have undergone DBS-STN with mixed results. They suggest that 2 factors predicted their patient’s poor outcome to DBS-STN; 1. lack of response preoperatively to levodopa in her lower extremity motor function, posture, and hypophonia, 2. preoperative suspicion of MSA. They recommend against using DBS-STN for MSA patients.

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