Sustained dyskinesias following elective cessation and reactivation of chronic subthalamic nucleus deep brain stimulation for a surgical procedure.

ABSTRACT

OBJECTIVES: Subthalamic nucleus deep brain stimulation (STN DBS) is effective for treatment of levodopa-induced dyskinesias in patients with Parkinson's disease (PD). Medical or surgical procedures requiring electrocautery may require inactivation of the pulse generators to avoid damage to the lead or extension wire or possible reprogramming of the stimulators. This generally causes only mild and temporary disability. We report a patient with previously well-controlled dyskinesias who had severe and prolonged dyskinesias following reactivation of deep brain stimulation (DBS) following an orthopedic procedure. MATERIALS AND METHODS: Retrospective chart review. RESULTS: The patient underwent two orthopedic procedures, each requiring inactivation of DBS. After reactivation of DBS, the patient experienced severe dyskinesias that ultimately required sedation and ventilation to control large-amplitude dyskinesias. CONCLUSIONS: Clinicians caring for PD patients treated with STN DBS should be aware of the possible reappearance of severe dyskinesias arising from routine inactivation and reactivation of pulse generators for medical or surgical procedures.