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Published on: January 6, 2011
Deep brain stimulation of the internal segment of the globus pallidus in delayed runaway dyskinesia
John Graff-Radford1, Kelly D Foote, Ramon L Rodriguez
1Department of Neurology, University of Florida Movement Disorders Center, University of Florida, Gainesville, FL, USA.
Background:
Dyskinesias that occur during a period without medication after embryonic cell transplantation have been commonly reported in double-blind trials; however, to date, they have not been reported in the few patients who participated in open-label pilot studies.
Design:
Single case observation with preoperative and postoperative data, and intraoperative single-cell physiology.
Patient:
A patient who underwent embryonic cell transplantation in 1993 as part of the University of South Florida open-label study was referred for evaluation of intractable dyskinesia of the right arm. The dyskinesia was present during evaluation of the patient after a 12-hour period without medication and was clinically disabling. It was manifested as a severe groping movement of the hand. Intraoperative physiologic evaluation revealed decreased firing rates in the internal segment of the globus pallidus.
Results:
Deep brain stimulation of the internal segment of the globus pallidus resulted in resolution of the dyskinesia.
Conclusion:
This case highlights the delayed development of runaway dyskinesia after a period without medication as an important potential long-term adverse effect of embryonic cell transplantation in patients with Parkinson disease.
