- Neurosurgery, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
- Department of Neurology, University of Arizona, Tucson, Arizona, USA
Department of Neurology, University of Arizona, Tucson, Arizona, USA
DOI:10.4103/2152-7806.194063Copyright: © 2016 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Jean-Philippe Langevin, Jesse M. Skoch, Scott J. Sherman. Deep brain stimulation of a patient with psychogenic movement disorder. 14-Nov-2016;7:
How to cite this URL: Jean-Philippe Langevin, Jesse M. Skoch, Scott J. Sherman. Deep brain stimulation of a patient with psychogenic movement disorder. 14-Nov-2016;7:. Available from: http://surgicalneurologyint.com/surgicalint_articles/deep-brain-stimulation-patient-psychogenic-movement-disorder/
Background:The long-term safety of deep brain stimulation (DBS) is an important issue because new applications are being investigated for a variety of disorders. Studying instances where DBS was inadvertently implanted in patients without a movement disorder may provide information about the safety of the therapy. We report the case of a patient with a psychogenic movement disorder treated with deep brain stimulation (DBS).
Case Description:The patient presented at our clinic after 5 years of chronic DBS of the subthalamic nucleus (STN) for presumed Parkinson's disease. A dopamine transporter (DAT) scan (DaTscan) showed normal DAT distribution in the striatum. A positron emission tomography (PET) scan showed no abnormal metabolic patterns. Further psychiatric and neurological evaluations revealed that the patient was suffering from a psychogenic movement disorder. The patient displayed no sign or symptom from the stimulation, and DBS did not lead to any benefits or side effects for this patient.
Conclusion:We argue that the absence of side effects, the normal DaTscan, and PET scan after 5 years of chronic stimulation illustrate the safety of DBS on neural tissue.
Keywords: Deep brain stimulation, functional imaging, Parkinson's disease, psychogenic movement disorder
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) leads to symptoms reduction and functional improvements in Parkinson's disease (PD) patients.[
Our patient initially presented with right upper extremity tremor that eventually generalized to all extremities. He was diagnosed with Parkinson's disease but failed to respond to various medications including levodopa and pramipexole. One year later, he was deemed refractory to medical therapy and underwent the implantation of a DBS system in the STN bilaterally. Five years later, the patient moved to our state and was seen in our clinic.
During our assessment, the patient complained of freezing episodes and dystonic movements wherein he would drool, become aphasic, and experience arm flexion and toe curling. The patient reported that these episodes occurred approximately 3–4 times daily and lasted 5–10 minutes, with no identifiable triggers and no relationship to his medication dosing. DBS did not improve his symptoms, and he had undergone a trial with DBS off for thirty days and noted no significant difference in his symptoms. The patient was taking Sinemet, pramipexole, trihexiphenidyl, Apokyn with no significant benefit. He experienced no benefit from additional medications for presumed dystonic spells including topiramate and rasagiline.
We confirmed the proper placement of DBS leads in the STN bilaterally with magnetic resonance imaging (MRI). The DBS system was programmed for monopolar stimulation using the more ventral contacts with a pulse width of 60 μs, a frequency of 185 Hz, and amplitude of 2.8 V. We obtained a 18F-fluorodeoxyglucose (FDG) PET study of the brain to identify DBS-related alterations in cerebral metabolism that could explain the symptoms [
A dopamine transporter nuclear study (DaTscan) was performed. The study revealed normal distribution of the dopamine transporter within the striatum [
Psychogenic movement disorder is a challenging condition, and it can be difficult to differentiate it from a true movement disorder. For instance, a recent study reported on two patients with psychogenic dystonia who underwent DBS. In these cases as well, the patients did not suffer from stimulation-related side effects.[
Previous studies have demonstrated the long-term safety of DBS from an anatomical perspective by confirming the absence of significant tissue lesion on postmortem evaluations.[
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