[Deep-brain stimulation of the internal pallidum in multiple system atrophy].
BACKGROUND
The experience with deep-brain stimulation (DBS) in multiple-system atrophy (MSA) is sparse and generally disappointing. DBS is currently not recommended in MSA and its use is often related to a misdiagnosis.


METHODS
We describe the outcome of bilateral DBS of the internal pallidum in a 46-year-old woman suffering from MSA that initially resembled Parkinson's disease with prominent levodopa-induced dyskinesias. DBS of the left internal pallidum was performed in 1998 after a ten-year clinical course and improved dyskinesias. Six months later, the right side was implanted. A few months after the second surgery, the patient progressively developed signs of cerebellar and dysautonomic impairment and MSA was diagnosed.


CONCLUSIONS
Our observation confirms the ineffectiveness of DBS of the internal pallidum in MSA and even suggests a harmful effect. DBS remains contra-indicated in atypical parkinsonism.
Lambrecq
V
V
Département de neurologie, groupe hospitalier sud, CHU de Bordeaux, Bordeaux, France.
Krim
E
E
Meissner
W
W
Guehl
D
D
Tison
F
F
D046690:Deep Brain Stimulation / Q000009:adverse effects; D020820:Dyskinesias / Q000209:etiology / Q000628:therapy; D004567:Electrodes, Implanted; D005260:Female; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000628:therapy*; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D017211:Treatment Failure