Objective: To report a patient with Parkinson’s disease (PD) in whom apraxia of eyelid opening (ALO) improved after the change of another implantable pulse generator (IPG) for subthalamic nucleus deep brain stimulation (STN-DBS).

Background: Several studies have reported the incidence of ALO between 6.1 to 11.3% after STN-DBS, but the exact mechanism of ALO is not well understood. It is difficult to treat ALO by adjusting stimulation of STN-DBS.

Methods: A 60-year-old woman with a 20-year history of PD received bilateral STN-DBS surgery at the age of 49, because of motor fluctuations and dyskinesia. She underwent the surgery to replace the right electrode lead at the age of 55, because of akinesia. A half year after the surgery, akinesia emerged again. Thus, the left electrode lead was exchanged. Then akinesia somewhat improved, but ALO appeared.

Results: Four years after the last operation, she visited to our hospital. We changed to another IPG with Multiple Independent Current Control (MICC), because the voltage of right-side IPG could not be maintained. By adjusting the IPG with MICC, ALO and akinesia significantly improved.

Conclusions: Changing the IPG should be considered in a patient with PD in whom ALO emerged following STN-DBS.

References: Tommasi G, Krack P, Fraix V, et al. Effects of varying subthalamic nucleus stimulation on apraxia of lid opening in Parkinson’s disease. J Neurol. 2012; 259:1944-50. Umemura A, Oka Y, Yamamoto K, et al. Neurol Med Chir. 2011; 51:749-55. Complications of subthalamic nucleus stimulation in Parkinson’s disease.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/improvement-of-apraxia-of-eyelid-opening-in-a-patient-with-parkinsons-disease-following-the-change-of-the-implantable-pulse-generator-for-subthalamic-nucleus-deep-brain-stimulation/