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Case Report: Globus Pallidus Internus (GPi) Deep Brain Stimulation Induced Keyboard Typing Dysfunction.

Joshua K Wong1, Melissa J Armstrong1, Leonardo Almeida1

  • 1Department of Neurology, McKnight Brain Institute, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States.

Frontiers in Human Neuroscience
|November 26, 2020
PubMed
Summary

Dystypia, an impaired ability to type, can be a rare side effect of Globus Pallidus Internus deep brain stimulation (DBS). This condition may involve the superior longitudinal fasciculus (SLF) and improves when DBS is turned off.

Keywords:
connectomicsdeep brain stimulationdystoniadystypiastimulation induced side effect

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Area of Science:

  • Neuroscience
  • Neurology
  • Neurosurgery

Background:

  • Typing involves complex visuospatial memory, language, and motor functions.
  • Dystypia is defined as impaired typing ability unrelated to motor deficits, apraxia, or aphasia.
  • Deep brain stimulation (DBS) is a treatment for movement disorders like dystonia.

Purpose of the Study:

  • To investigate a case of dystypia following bilateral pallidal deep brain stimulation (DBS).
  • To explore the neuroanatomical correlates of stimulation-induced dystypia.
  • To determine if dystypia is a reversible side effect of DBS.

Main Methods:

  • A 68-year-old woman with dystonia received bilateral Globus Pallidus Internus (GPi) DBS.
  • Serial typing tests were conducted with DBS ON and OFF.
  • Post-operative lead reconstruction and tractography were performed using Lead-DBS software.
  • Volume of Tissue Activation (VTA) modeling was combined with whole-brain tractography.

Main Results:

  • Typing ability significantly improved when the DBS device was turned OFF.
  • Cortical mapping showed modulation of the right angular gyrus, left calcarine fissure, and left cuneus.
  • Bilateral supplemental motor areas and superior parietal gyri were activated during stimulation.
  • Connectivity analysis suggested involvement of the superior longitudinal fasciculus (SLF).

Conclusions:

  • Dystypia can be a rare, stimulation-induced side effect of GPi DBS therapy.
  • The findings suggest a potential association between dystypia and SLF involvement.
  • Reversible dystypia highlights the complex interplay between DBS, brain networks, and cognitive-motor functions.