Abstract Details

Title Dorsal GPi/GPe DBS Induced Dyskinesia

Topic Movement Disorders

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-037

Objective

To describe stimulation-induced dyskinesia (SID) observed in Parkinson’s disease (PD) patients with globus pallidus internus (GPi) deep brain stimulation (DBS)

Background While SID is commonly seen in STN DBS patients, it is rarely reported with GPi DBS. Few studies correlated the incidence of SID with precise anatomic localization of the stimulation site. Although typically effective in improving motor symptoms of PD and suppressing problematic dyskinesia, dorsal GPi/GPe DBS can rarely precipitate SID

Design/Methods Four patients with PD treated with GPi DBS developed SID. GPi DBS lead localization was performed using a delayed postoperative CT fused with a preoperative MRI and a patient-specific 3-D morph of a modified Schaltenbrand and Bailey brain atlas. We analyzed the occurrence of dyskinesia, the precise lead location, and the active DBS contact used for chronic treatment

Results Three of the four patients were implanted with bilateral, and one with unilateral, GPi DBS. Five of seven leads were deemed optimally placed (OP) and two suboptimally placed (SP) in the GPI based on imaging and programming thresholds. Four leads produced SID (OP n=2, SP n=2, right n=1, left n=3). SID occurred when dorsal (contacts 2, 3), but not ventral (contacts 0, 1) DBS contacts were activated. Stimulation at dorsal contacts provided motor benefit and were more likely to be used for chronic DBS. SID was voltage dependent in three patients and was elicited at stable parameters for testing(135Hz and 90µs). One patient developed leg dyskinesia at higher frequency (180Hz)

Conclusions Dorsal GPi stimulation can be pro-kinetic, but rarely produces contralateral dyskinesia. The finding was confirmed in n=4 patients however these patients were selected based on the occurrence of SID during GPI DBS programming. We suspect that SID incidence is low in GPI DBS patients. Studies of tractography and volume of tissue activation (VTA) may clarify relevant circuitry of the GPe/GPi

Authors/Disclosures
Ahmad El Kouzi, MD, FAAN PRESENTER	Dr. El Kouzi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie.
Shannon Y. Chiu, MD, MSc (Mayo Clinic Arizona)	Dr. Chiu has received research support from NIH.
Matthew R. Burns, MD, PhD (University of Florida)	The institution of Dr. Burns has received research support from NIH. The institution of Dr. Burns has received research support from Mcknight Brain Institute.
Robert S. Eisinger, MD, PhD	The institution of Dr. Eisinger has received research support from NIH.
Leonardo Almeida (University of Florida College of Medicine - Neurology)	No disclosure on file
Adolfo Ramirez Zamora, MD (University of Louisville)	Dr. Ramirez Zamora has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerevel therapeutics. Dr. Ramirez Zamora has received personal compensation in the range of $0-$499 for serving as a Consultant for NeuroPacs. Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Scientific. Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Iota Inc. Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Maplight. Dr. Ramirez Zamora has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. The institution of Dr. Ramirez Zamora has received research support from Parkinsons Foundation.
Kelly D. Foote, MD	Kelly D. Foote, MD has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Axio/Neurocrine Biosciences.
Michael S. Okun, MD, FAAN (University of Florida)	Dr. Okun has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Okun has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Parkinson's Foundation. Dr. Okun has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Okun has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Journal Watch. The institution of Dr. Okun has received research support from NIH. The institution of Dr. Okun has received research support from Parkinson's Foundation. The institution of Dr. Okun has received research support from Tourette Association of America. The institution of Dr. Okun has received research support from Michael J Fox. Dr. Okun has received publishing royalties from a publication relating to health care.
Wissam G. Deeb, MD (UMass Memorial)	Dr. Deeb has a non-compensated relationship as a Board member with Davis Phinney Foundation that is relevant to AAN interests or activities.

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