Objective: To describe a clinical case of buccinator movements evoked by subthalamic nucleus deep brain stimulation (STN-DBS) in a patient with advanced Parkinson’s disease (PD) that are spatially correlated with somatotopic area corresponding to face.

Background: Subthalamic nucleus (STN) has a role in modulating outputs of basal nuclei and is the most effective target for surgical treatment of cardinal motor symptoms and motor and non-motor complications of PD. Anatomical and microelectrode recording studies have demonstrated a somatotopic organization of subthalamic nucleus.

Method: A 51-year-old male with PD, starting at 35 with an LRRK2 mutation, had bilateral STN-DBS implantation in May 2021. In July 2023, he experienced motor deterioration due to a depleted generator battery. After replacement, strong buccinator muscle movements were induced mainly by the left STN. Adjusting stimulation resolved the issue.

Results: Stimulation-induced-dyskinesias (SID) has been widely reported in PD and are considered a positive predictor of DBS outcome. They appear in extremities or trunk and most described as dystonic, ballistic or choreic movements. When dyskinesia is severe, stimulation of dorsal areas can alleviate it. In our patient, dyskinetic movements of buccinator muscles induced by acute stimulation of STN correlate with homunculus of dorsolateral region of STN that corresponds to primary motor cortex, where facial musculature is represented. These movements have been called “orobuccal Popeye sign” , which can be explained by a rebound phenomenon, related to an acute increase of electric stimulation of STN generating increased mobility.

Conclusion: This case has allowed us to correlate somatotopic body representation in STN, with reversible orobuccal dyskinesias induced by acute stimulation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/surprising-somatotopy-buccinator-dyskinesia-orobuccal-popeye-sign-induced-by-subthalamic-brain-stimulation-in-parkinsons-disease/