Objective: We report a case of medication-refractory poststroke hemichorea where deep brain stimulation of the globus pallidus internus (GPi-DBS) was utilized to alleviate hemichorea.

Background: Poststroke hemichorea is a rare involuntary hyperkinetic disorder involving one side of the body and can result from lesions in the contralateral subthalamic nucleus (STN), thalamus, and other brain areas. Majority of patients with poststroke hemichorea show an effective response to treatment with spontaneous resolution over time. In medically refractory cases, surgical interventions could be applied to control symptoms including thalamotomy, pallidotomy, or pallidal deep brain stimulation.

Method: a case report

Results: A 79-year-old woman presented with right hemichorea one month after hypertensive intracerebral hemorrhage at subthalamic nucleus and thalamus on the left. Hemichorea was more affected in the leg than the arm where both proximal and distal leg was involved. Hemichorea was aggravated by voluntary movements and walking. All effective medications were applied to control symptoms including antipsychotics, antiepileptic drugs, and amantadine, but they did not improve hemichorea to the level of independent functional status. After 4 years of follow-up, hemichorea sustained and was considered as medication-refractory. Although her age was higher than the mean age at surgery of previous cases that DBS was applied to poststroke hemichorea or hemiballism, GPi-DBS was determined according to the patient’s strong will to surgery. After GPi-DBS on the left, she showed residual hemichorea on the distal part of the leg, but the degree of symptoms improved to the level of walking alone. The effect of pallidal stimulation for hemichorea has been maintained for 1 year.
Conclusions:

Conclusion: In this case, pallidal DBS showed sustained response to medically refractory poststroke hemichorea for 1 year.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pallidal-deep-brain-stimulation-for-treatment-of-poststroke-hemichorea/