Objective: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for motor symptoms in advanced Parkinson’s disease (PD). However, autonomic side effects may occur during programming. We report a unique case of Raynaud’s phenomenon, characterized by vasospasms of the fingers, and diaphoresis during initial STN DBS programming.

Background: STN DBS is known to impact motor function in PD, but its effects on the autonomic nervous system are less well understood. Autonomic side effects such as changes in blood pressure, gastrointestinal function, bladder control, and hyperhidrosis have been reported. However, Raynaud’s phenomenon, a condition involving episodic vasospasms of the fingers and toes, has not been previously described in the context of DBS programming.

Method: Case report

Results: A 50-year-old male with young-onset Parkinson Disease with genetic testing positive for GBA 1,TAF1 , ATP7B , PLA2G6  and apathy who underwent bilateral STN DBS. During initial programming with high amplitude in contacs 2 and 10, he developed Raynaud’s phenomenon, presenting as vasospasms, color and temperature changes in both hands.  Figure 1a. and 1b. Additionally, he experienced right-sided diaphoresis and a sensation of heat. These symptoms resolved with stimulation cessation, and final DBS parameters were adjusted accordingly.

Conclusion: The occurrence of Raynaud’s phenomenon and diaphoresis during STN DBS programming suggests an acute impact on sympathetic tone and autonomic function. This may be due to stimulation of central autonomic fibers originating from the lateral hypothalamus, which lie in close proximity to the STN. In this patient the ventromedial location of the DBS electrodes, targeting both motor and limbic regions, may have contributed to these autonomic effects. This case highlights the potential for autonomic side effects, particularly Raynaud’s phenomenon and diaphoresis, during STN DBS programming in PD. Further research is needed to elucidate the neural mechanisms underlying autonomic responses to neuromodulation and to optimize programming strategies.

Raynaud’s phenomenon 1a.

Raynaud’s phenomenon 1b.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/raynauds-phenomenon-and-diaphoresis-during-initial-programming-of-subthalamic-nucleus-deep-brain-stimulation-in-parkinsons-disease-a-case-report/