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Malignant Subthalamic Nucleus‐Deep Brain Stimulation Withdrawal Syndrome in Parkinson's Disease
Author(s) -
Rajan Roopa,
Krishnan Syam,
Kesavapisharady Krishna Kumar,
Kishore Asha
Publication year - 2016
Publication title -
movement disorders clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.754
H-Index - 18
ISSN - 2330-1619
DOI - 10.1002/mdc3.12271
Subject(s) - deep brain stimulation , medicine , parkinson's disease , subthalamic nucleus , disease , withdrawal syndrome , pediatrics , intensive care medicine , physical medicine and rehabilitation , anesthesia
Abrupt cessation of STN ‐ DBS is an under‐recognized cause of life‐threatening akinetic crisis in Parkinson's disease ( PD ) and can present as a movement disorder emergency. We report on 2 patients who survived severe and prolonged akinetic crisis after abrupt cessation of STN stimulation for PD (malignant STN ‐ DBS withdrawal syndrome). We discuss the clinical similarities and possible differences in pathophysiology from the akinetic crisis in medically‐treated PD . Although early implantable pulse generator ( IPG ) replacement is the definitive treatment, medical and economic considerations may preclude early surgery and strategies for medical management assume importance. We reflect upon the socioeconomic concerns surrounding DBS in countries lacking health care coverage and the need for user‐independent monitors and indicators of low IPG battery status.