Deep brain stimulation of the internal segment of the globus pallidus in delayed runaway dyskinesia.
BACKGROUND
Dyskinesias that occur during a period without medication after embryonic cell transplantation have been commonly reported in double-blind trials; however, to date, they have not been reported in the few patients who participated in open-label pilot studies.


METHODS
Single case observation with preoperative and postoperative data, and intraoperative single-cell physiology.


METHODS
A patient who underwent embryonic cell transplantation in 1993 as part of the University of South Florida open-label study was referred for evaluation of intractable dyskinesia of the right arm. The dyskinesia was present during evaluation of the patient after a 12-hour period without medication and was clinically disabling. It was manifested as a severe groping movement of the hand. Intraoperative physiologic evaluation revealed decreased firing rates in the internal segment of the globus pallidus.


RESULTS
Deep brain stimulation of the internal segment of the globus pallidus resulted in resolution of the dyskinesia.


CONCLUSIONS
This case highlights the delayed development of runaway dyskinesia after a period without medication as an important potential long-term adverse effect of embryonic cell transplantation in patients with Parkinson disease.
Graff-Radford
John
J
Department of Neurology, University of Florida Movement Disorders Center, University of Florida, Gainesville, FL, USA.
Foote
Kelly D
KD
Rodriguez
Ramon L
RL
Fernandez
Hubert H
HH
Hauser
Robert A
RA
Sudhyadhom
Atchar
A
Rosado
Christian A
CA
Sanchez
Justin C
JC
Okun
Michael S
MS
D046690:Deep Brain Stimulation / Q000379:methods*; D020820:Dyskinesias / Q000503:physiopathology / Q000628:therapy*; D005917:Globus Pallidus / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy; D033581:Stem Cell Transplantation / Q000009:adverse effects