title: Sustained dyskinesias following elective cessation and reactivation of chronic subthalamic nucleus deep brain stimulation for a surgical procedure.
abstract: OBJECTIVE
  Subthalamic nucleus deep brain stimulation (STN DBS) is effective for treatment of levodopa-induced dyskinesias in patients with Parkinson's disease (PD). Medical or surgical procedures requiring electrocautery may require inactivation of the pulse generators to avoid damage to the lead or extension wire or possible reprogramming of the stimulators. This generally causes only mild and temporary disability. We report a patient with previously well-controlled dyskinesias who had severe and prolonged dyskinesias following reactivation of deep brain stimulation (DBS) following an orthopedic procedure.
  
  
  METHODS
  Retrospective chart review.
  
  
  RESULTS
  The patient underwent two orthopedic procedures, each requiring inactivation of DBS. After reactivation of DBS, the patient experienced severe dyskinesias that ultimately required sedation and ventilation to control large-amplitude dyskinesias.
  
  
  CONCLUSIONS
  Clinicians caring for PD patients treated with STN DBS should be aware of the possible reappearance of severe dyskinesias arising from routine inactivation and reactivation of pulse generators for medical or surgical procedures.
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA. lshih@bidmc.harvard.edu
authors.forename: Ludy C
authors.initials: LC
authors.lastname: Shih
authors.forename: Veronique
authors.initials: V
authors.lastname: Vanderhorst
authors.forename: Efstathios
authors.initials: E
authors.lastname: Papavassiliou
authors.forename: Daniel
authors.initials: D
authors.lastname: Tarsy
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D020820:Dyskinesias / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D017558:Elective Surgical Procedures / Q000295:instrumentation; D005260:Female; D006801:Humans; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000502:physiology