Category: Parkinson's Disease: Neurophysiology
Objective: We report on a patient with Parkinson’s disease (PD) who developed reversible Progressive Supranuclear Palsy (PSP) like phenotype after bilateral subthalamic nuclear (STN) deep brain stimulation (DBS). The post-operative local field potential (LFP) from DBS leads and brain MRI will be presented and discussed.
Background: STN DBS is a standard treatment for advanced PD. However, stimulation-related side effects often impede therapeutic benefits. These adverse effects are commonly associated with suboptimal electrode implantation or stimulation programming. We herein report a 70-year-old woman with idiopathic PD who developed PSP-like phenotype after bilateral STN DBS. She was diagnosed as idiopathic PD 16 years before the operation and underwent bilateral STN DBS for the treatment of motor fluctuation. Before operation, her response to dopaminergic medicine remained excellent and there was no vertical gaze palsy (VSGP), bulbar symptoms, or retrocollis. MRI showed no evidence of midbrain atrophy or organic lesions. Her motor impairments were significantly alleviated by stimulation but she developed VSGP, retrocollis and bulbar symptoms one year after surgery.
Method: Post-operative LFP was recorded from implanted DBS electrode one day after implantation. The location of each contact of DBS was reconstructed by LEAD-DBS.
Results: The PSP-like phenotype subsided after reprogramming the stimulation parameters: changed the contact ventrally (C3/C11 to C1/C8) and reduced the stimulation frequency (130 Hz to 90 Hz).
Conclusion: Previous literatures reported VSGP resulting from deviated electrode positioning located in the zona incerta. Our case is not consistent with these reports, as the reconstructed post-MRI reveals that the pathological contact was not within zona incerta. The location of the stimulation contact, post-operative LFPs from DBS lead, and possible mechanisms behind these unusual side effects will be discussed.
To cite this abstract in AMA style:
W-H. Chang, Y-C. Chen, P-L. Chen, P-H. Tu, C-H. Yeh, T-C. Liu, C-S. Lu, C-C. Chen. PSP-like phenotype triggered by STN DBS in PD: a case report [abstract]. Mov Disord. 2023; 38 (suppl 1). https://www.mdsabstracts.org/abstract/psp-like-phenotype-triggered-by-stn-dbs-in-pd-a-case-report/. Accessed June 13, 2025.« Back to 2023 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/psp-like-phenotype-triggered-by-stn-dbs-in-pd-a-case-report/