Session Time: 12:00pm-1:30pm
Location: Exhibit Hall located in Hall B, Level 2
Objective: To present a case of levodopa induced foot dystonia that improved with 60Hz frequency subthalamic- deep brain stimulation.
Background: Deep Brain Stimulation is an effective therapeutic modality for the treatment of primary generalized and segmental dystonia. The globus pallidus interna (GPi) is the commonest implanted target with programming parameters of large amplitudes, long pulse widths and high frequencies ranging between 130 and 185Hz often utilized. However, 60Hz Frequency stimulation of the GPi has been shown to be beneficial for primary dystonia as well. In addition, several studies demonstrate improvement of primary dystonia in patients implanted with Subthalamic-DBS.
Methods: We report a 62-year-old man with an 18 year history of Parkinson’s disease(PD) that was implanted with bilateral subthalamic nucleus deep brain stimulators 7 years ago and presented for a second opinion on management of his DBS. His initial PD symptoms included left sided rigidity and bradykinesia that responded robustly to levodopa. Over time, motor fluctuations developed causing his dopaminergic requirement to rise. Despite marked reduction in rigidity and bradykinesia in his levodopa ON state, he also had a right foot dystonia that was characterized by inversion of his ankle that occurred when walking and disappeared when his levodopa had worn off. STN-DBS with 170Hz frequency improved his cardinal PD symptoms, but did not affect the foot dystonia. Botulinum toxin injections failed to provide sufficient benefit as well. During his initial visit, he was examined in the medicated state and found to have no dystonia or dyskinesia at rest. When walking, his right foot inverted with each stride and straightened when walking backwards and running.
Results: The frequency on the left impulse generator was switched from 170 Hz to 60 Hz with immediate improvement of the right foot dystonia observed. The amplitude remained at 2.1V during the adjustment of frequency. This benefit was sustained on subsequent follow-up. Video of the foot dystonia at 170Hz and 60Hz was obtained to further illustrate the observed phenomena.
Conclusions: This case illustrates foot dystonia as a levodopa ON phenomenon that was responsive to 60Hz frequency STN-DBS.
To cite this abstract in AMA style:J.P. Battista, R.A. Ramdhani. Improvement of levodopa induced foot dystonia with 60 Hz frequency subthalamic- deep brain stimulation [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/improvement-of-levodopa-induced-foot-dystonia-with-60-hz-frequency-subthalamic-deep-brain-stimulation/. Accessed September 22, 2023.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/improvement-of-levodopa-induced-foot-dystonia-with-60-hz-frequency-subthalamic-deep-brain-stimulation/