Objective: We present a case of development of malignant glioma (glioblastoma multiforme) in the area adjacent to electrostimulation zone in a patient with chronic STN-DBS, which raises an important issue of a causal relationship between these events.

Background: DBS of subthalamic nucleus is a highly effective and relatively safe method of treatment of advanced Parkinson’s disease (PD). There is no clear evidence of the influence of electromagnetic radiation on blastomatosis. In the literature available, we have not discovered other cases of glioblastoma progression in the region directly connected and stimulated by DBS-electrode.

Methods: A 52-year-old male with the left-side dominant PD (Hoehn&Yahr stage 3) underwent bilateral STN-DBS in October 2008.

Results: Following the next six years, a stable significant decrease in severity of Parkinsonian symptoms, motor fluctuations, and drug-induced dyskinesia was observed. In September 2014, we observed a progressive deterioration of neurological state resulting in weakness of the left limbs and unsteady gait. Transient speech disturbance and confusion appeared in December 2014. MRI revealed an intracerebral tumor of the right thalamus and cerebral peduncle around the lead with obstructive hydrocephaly. Neurological examination showed prominent ataxia, left-sided hemiparesis, vertical gaze palsy, executive dysfunction, and memory impairment. We performed stereotactic biopsy of the tumor and ventriculoperitoneal shunting simultaneously. Cerebral symptoms and balance disturbances partially regressed after shunting. Biopsy result was glioblastoma multiforme. Subsequent radio- and chemotherapy was scheduled. DBS-system was not explanted due to preserved strong DBS effect and significant worsening of Parkinsonian symptoms in off-stimulation condition.

Conclusions: Glioblastoma is the most widespread primary brain tumor of neuroectodermal origin. Etiology of glioblastoma remains unclear. Current clinical observation alone could not prove a relationship between DBS and development of malignant glioma in the area of electrode implantation and electrostimulation. Most likely, we observed two independent states, accidental case of glioblastoma formation in a DBS-patient. However, probability of tumor induction by electromagnetic field of DBS-electrode could not be excluded. Further research on safety of DBS is necessary.

WSSFN Interim Meeting 2015, 3-6 September, Mumbai, India.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-case-of-thalamic-malignant-glioma-formation-in-a-patient-with-stn-dbs-for-parkinsons-disease/