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Choreatic side-effects of deep brain stimulation of the anteromedial subthalamic nucleus for treatment-resistant obsessive-compulsive disorder: a case report.
World Neurosurg. 2017 May 19;:
Authors: Mulders AEP, Leentjens AFG, Schruers K, Duits A, Ackermans L, Temel Y
Abstract
BACKGROUND: Patients with treatment-resistant obsessive-compulsive disorder (OCD) are potential candidates for deep brain stimulation (DBS). The anteromedial subthalamic nucleus (STN) is amongst the most commonly used targets for DBS in OCD.
CASE DESCRIPTION: We present a patient with a 30-year history of treatment-resistant OCD who underwent anteromedial STN-DBS. Despite a clear mood-enhancing effect, stimulation caused motor side-effects including bilateral hyperkinesia, dyskinesias and sudden large amplitude choreatic movements of arms and legs when stimulating at voltages above circa 1.5V. DBS at lower amplitudes and at other contact points failed to result in a significant reduction of obsessions and compulsions without inducing motor side-effects. Due to this limitation in programming options, we decided to re-operate and target the ventral capsule/ventral striatum (VC/VS), which resulted in a substantial reduction in key obsessive and compulsive symptoms without serious side-effects.
CONCLUSION: Choreatic movements and hemiballismus have previously been linked to STN dysfunction and have been incidentally reported as side-effect of DBS of the dorsolateral STN in Parkinson's disease (PD). However, in PD, these side-effects were usually transient and rarely interfered with DBS programming. In our case, the motor side-effects were persistent and made optimal DBS programming impossible. To our knowledge such severe and persistent motor side-effects have not yet been described for anteromedial STN-DBS.
PMID: 28532905 [PubMed - as supplied by publisher]
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