Session Information
Date: Saturday, October 6, 2018
Session Title: Surgical Therapy: Parkinson's Disease
Session Time: 1:45pm-3:15pm
Location: Hall 3FG
Objective: In this case report, we describe the development of hemidystonia due to hemorrhagic complication after subthalamic deep brain stimulation (STN-DBS) in a patient with Parkinson’s disease (PD). To our knowledge, this surgical complication has never been reported.
Background: Intraoperative bleeding is a possibile complication of DBS, sometimes leading to chronic disability.
Methods: A 59-year-old woman with PD developed a left hemiparesis immediately after STN-DBS, due to right midbrain hemorrhage (Figure 1). In addition to pyramidal signs, we observed a complete resolution of left limbs rigidity due to a lesional effect, while the right parkinsonian signs improved with unilateral left STN-DBS.
Results: After a 2-months intensive rehabilitation, left hemiparesis greatly improved, without the recurrence of parkinsonian signs. Unfortunately, the patient progressively developed a left hemidystonia, not responsive either to right STN-DBS and to oral therapy. Therefore, hemidystonia was treated with botulinum toxin injections, with a complete resolution on upper limb and partial responsiveness on lower limb.
Conclusions: Hemorrhage is probably the most severe complication of DBS, with an incidence of about 5% (1). The most frequent sequelae are changes in consciousness, hemiparesis and visual loss. Secondary dystonia has been described in a few cases after midbrain hemorrhage but, to our knowledge, it has never been reported as STN-DBS complication (2). In our case, the combination of unilateral STN-DBS and botulinum toxin treatment lead to a quite good control of either parkinsonian and dystonic features.
References: 1) Zrinzo L, et al. Reducing hemorrhagic complications in functional neurosurgery: a large case series and systematic literature review. J Neurosurg 2012;116:84-94. 2) Muñoz EJ, et al. Upper-limb dystonia secondary to a midbrain hemorrhage. Mov Disord 1996;11:96-99.
To cite this abstract in AMA style:
G. Sciacca, S. Bonvegna, F. Dematteis, M. Lanotte, A. Romagnolo, L. Lopiano, U. Dimanico, M. Rizzone. Hemidystonia due to midbrain hemorrhage: An unusal complication of Deep Brain Stimulation [abstract]. Mov Disord. 2018; 33 (suppl 2). https://www.mdsabstracts.org/abstract/hemidystonia-due-to-midbrain-hemorrhage-an-unusal-complication-of-deep-brain-stimulation/. Accessed October 7, 2024.« Back to 2018 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/hemidystonia-due-to-midbrain-hemorrhage-an-unusal-complication-of-deep-brain-stimulation/