Abstract Details

Title Simultaneous Improvement of Tics and Dug-Induced Parkinsonism after Gpi DBS: A Case Report

Topic Clinical Neurophysiology

Presentation(s) IN11 - (-)

Poster/Presentation
Number 006

Objective

Background GPi DBS is commonly used in the treatment of Parkinson's disease and dystonia, and small case series describe efficacy in the treatment of medically-refractory TS. Dopamine receptor blockers and depletors are often used for tic suppression and/or treatment of psychiatric comorbidities in TS can cause DIP, which can limit their use.

Design/Methods A 21 year old right hand woman with malignant TS and comorbid obsessive compulsive disorder, attention deficit hyperactivity disorder and depression had marked reduction of tics with bilateral GPi DBS in combination with tetrabenazine 64.5mg per day and aripiprazole 5mg per day. Yale Global Tic Severity Scale (YGTSS) was performed pre-operatively and at 6 months. At 1 year, the patient was intermittently compliant with medications but subsequently rapidly retitrated them. 14 months after implantation DBS was briefly discontinued due to pain overlying the battery, during which time she was noted to have marked DIP. UPDRS was performed with stimulation turned OFF, 10 minutes after stimulation was resumed, and at 1month follow-up ON stimulation.

Results Baseline YGTSS-total was 89 and 42 at 6mos (47% improvement). MDS-UPDRS was 37 in the stimulator OFF condition at 14 months, 6 days after DBS therapy was stopped. With gradual amplitude titration to original settings, parkinsonism quickly resolved, MDS-UPDRS= 12 after 10 minutes. At one month follow-up DIP symptoms had improved further (MDS-UPDRS =3).

Conclusions Severe DIP in this patient may be secondary to rapid re-titration of anti-dopaminerigic medications. Furthermore, since TS and DIP have differing pathophysiology, this case report supports theories that DBS "normalizes" basal ganglia circuitry and can therefore treat both hyperkinetic and hypokinetic disorders occurring simultaneously.

Authors/Disclosures
Neepa J. Patel, MD, FAAN (Rush University Medical Center) PRESENTER	Dr. Patel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie Pharmaceuticals. Dr. Patel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amneal Pharmaceuticals. Dr. Patel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Supernius Pharmaceuticals. Dr. Patel has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Boston Scientific.
Joohi Jimenez Shahed, MD (Icahn School of Medicine at Mount Sinai)	Dr. Jimenez Shahed has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bracket Global LLC. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. Dr. Jimenez Shahed has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alpha Omega. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for RegenXBio. Dr. Jimenez Shahed has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Praxis. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kyowa Kirin. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BlueRock Therapeutics. Dr. Jimenez Shahed has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for PhotoPharmics. Dr. Jimenez Shahed has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Emalex. The institution of Dr. Jimenez Shahed has received research support from Michael J Fox Foundation. The institution of Dr. Jimenez Shahed has received research support from Amneal. The institution of Dr. Jimenez Shahed has received research support from Annovis. The institution of Dr. Jimenez Shahed has received research support from SAGE. The institution of Dr. Jimenez Shahed has received research support from Ono Pharmaceuticals. The institution of Dr. Jimenez Shahed has received research support from BlueRock. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Faculty with Movement Disorders Society. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Faculty with ��ɫ��. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Grant Reviewer with Parkinson Foundation. Dr. Jimenez Shahed has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant on Research Grant with Florida Atlantic University. Dr. Jimenez Shahed has received personal compensation in the range of $0-$499 for serving as a Speaker with Tourette Association of America. Dr. Jimenez Shahed has received personal compensation in the range of $5,000-$9,999 for serving as a Speaker with NACCME.
Richard Zorowitz	No disclosure on file

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