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Updated: Jul 17, 2025
Author Spotlight: Automated Deep Brain Stimulation for Parkinson's Disease - Exploring the Possibilities and Challenges of Home Monitoring
Published on: July 14, 2023
Identification and Management of Persistent Stimulation-Induced Dyskinesia Associated with STN DBS: The See-Saw
Matthew A Remz1,2, Joshua K Wong1,2, Justin D Hilliard1,3
1Fixel Institute for Neurological Diseases Campus, University of Florida, Gainesville, FL, USA.
Clinical Vignette:
A 73-year-old woman with Parkinson's disease (PD) underwent implantation of bilateral subthalamic nucleus deep brain stimulators (STN-DBS) to address bilateral upper extremity medication-refractory tremor. Post-operatively, she experienced a "see-saw effect" where small increases in stimulation resulted in improvement in one symptom (tremor) with concurrent worsening in another (dyskinesia).
Clinical Dilemma:
SID is usually considered a positive predictor of DBS outcome. However, there are cases where SID cannot be optimized. Lead location and pre-operative characteristics may contribute to this adverse effect. If the combination of programming and medication adjustments fails to resolve SID, what can be done to "rescue" the outcome?
Clinical Solution:
Management of SID requires a gradual and steadfast programming approach. Post-operative lead localization can guide advanced programming and decision-making. Rescue surgical interventions may be considered.
Gap In Knowledge:
In cases where SID is persistent despite deploying persistent optimization strategies, there is limited guidance on next steps.
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