Successful subthalamic stimulation, but levodopa-induced dystonia, in a genetic Parkinson's disease

Alessandro Stefani, Francesco Marzetti, Mariangela Pierantozzi, Simona Petrucci, Enrica Olivola, Salvatore Galati, Mario Stampanoni Bassi, Paola Imbriani, Enza Maria Valente, Francesco Saverio Pastore

Research output: Contribution to journalArticlepeer-review

Abstract

Recently, it is under scrutiny the possibility to anticipate the stereotactic implantation of the subthalamic nucleus (STN) even in relatively mild Parkinson's disease (PD) patients with an unsatisfying response to drugs. In addition, it is debated whether levodopa (LD) and deep brain stimulation (DBS) are congruent or, instead, mutually exclusive. A 56-year-old LRRK2-positive PD patient, with 7 years of disease history, dominated by severe left resting tremor, was submitted to bilateral implantation of the subthalamic nucleus (STN). Before surgery, the combination of LD and dopamine agonists failed to handle tremor unless administered at doses, which induced undesirable adverse events. STN deep brain stimulation (DBS) abolished tremor but did not provide satisfying control of hypokinetic-rigid symptoms. The condition STIM-ON plus LD, albeit transiently beneficial, installed a painful dystonia developing slowly after 24-36 h. Only a chronic therapy combining rotigotine plus STN-DBS proved effective without side effects. This case report, based upon the surprising difference between the therapeutic response to the combination of LD and dopamine agonist (before surgery) and the combination of DBS and agonist after surgery, emphasizes how STIM and LD target different motor domains through mechanisms with differential plasticity and confirms the efficacy of STN-DBS in LRKK2 patients.

Original languageEnglish
Pages (from-to)383-386
Number of pages4
JournalNeurological Sciences
Volume34
Issue number3
DOIs
Publication statusPublished - Mar 2013

Keywords

  • Dardarin
  • Deep brain stimulation
  • Levodopa
  • Parkinson's disease

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Dermatology

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