Objective: To document with videotaped observations, 3 patients with isolated dystonia who experienced stimulation-induced dyskinesia (SID) following subthalamic nucleus (STN) deep brain stimulation (DBS).

Background: The pallidum has been the preferred DBS target for dystonia, but recent studies have shown equal or greater improvement in patients implanted in STN(1). Transient SID is frequently observed when stimulating this novel target. There are no previously published video case reports of this phenomenon.

Methods: Patients were part of a cohort of 20 patients followed for 3 years as part of a prospective clinical trial on safety and efficacy of STN DBS for isolated dystonia(1). All study patients experienced transient SID, most commonly during programming. Three cases were videotaped while experiencing SID. Patient characteristics and SID phenomenology are described in detail.

Results: Case 1: 66-year-old man with a 3-year history of craniocervical dystonia. Following STN DBS, hand SID with arm posturing were noted when walking as semi-stereotyped piano-playing-like movements. Choreiform movements and foot dystonia also occurred in the ipsilateral leg. Case 2: 15-year-old boy, DYT1 mutation carrier, with a 1-year history of cervical and right arm dystonia. Upon system activation, SID developed as rotation of the right shoulder and jerky involuntary hand movements. Case 3: 48-year-old woman with a 3-year history of cervical dystonia. During initial programming, SID manifested as irregular jerking in both hands. SID typically presents immediately after stimulation changes, similar to those observed in STN DBS for Parkinson’s disease, but can also be delayed. SID vary phenotypically and may occur in body regions not previously affected by dystonia. Increasing voltage slowly, using more dorsal contacts, or bipolar stimulation often controls SID while still treating dystonia.

Conclusions: In isolated dystonia patients treated with STN DBS, SID is generally transient and resolves with programming. Providers should be aware that SID can occur after STN DBS for dystonia and not assume movements are the result of worsening isolated dystonia.

References: 1. Ostrem JL, San Luciano M, Dodenhoff KA, et al. Subthalamic nucleus deep brain stimulation in isolated dystonia: A 3-year follow-up study. Neurology 2017;88(1):25-35.

« Back to 2018 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/phenomenology-and-management-of-subthalamic-stimulation-induced-dyskinesia-in-a-video-case-series-of-patients-with-isolated-dystonia/