title: Successful subthalamic stimulation, but levodopa-induced dystonia, in a genetic Parkinson's disease.
abstract: Recently, it is under scrutiny the possibility to anticipate the stereotactic implantation of the subthalamic nucleus (STN) even in relatively mild Parkinson's disease (PD) patients with an unsatisfying response to drugs. In addition, it is debated whether levodopa (LD) and deep brain stimulation (DBS) are congruent or, instead, mutually exclusive. A 56-year-old LRRK2-positive PD patient, with 7 years of disease history, dominated by severe left resting tremor, was submitted to bilateral implantation of the subthalamic nucleus (STN). Before surgery, the combination of LD and dopamine agonists failed to handle tremor unless administered at doses, which induced undesirable adverse events. STN deep brain stimulation (DBS) abolished tremor but did not provide satisfying control of hypokinetic-rigid symptoms. The condition STIM-ON plus LD, albeit transiently beneficial, installed a painful dystonia developing slowly after 24-36 h. Only a chronic therapy combining rotigotine plus STN-DBS proved effective without side effects. This case report, based upon the surprising difference between the therapeutic response to the combination of LD and dopamine agonist (before surgery) and the combination of DBS and agonist after surgery, emphasizes how STIM and LD target different motor domains through mechanisms with differential plasticity and confirms the efficacy of STN-DBS in LRKK2 patients.
authors.affiliation: IRCCS Fondazione S. Lucia, Rome, Italy. stefani@uniroma2.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Stefani
authors.forename: Francesco
authors.initials: F
authors.lastname: Marzetti
authors.forename: Mariangela
authors.initials: M
authors.lastname: Pierantozzi
authors.forename: Simona
authors.initials: S
authors.lastname: Petrucci
authors.forename: Enrica
authors.initials: E
authors.lastname: Olivola
authors.forename: Salvatore
authors.initials: S
authors.lastname: Galati
authors.forename: Mario Stampanoni
authors.initials: MS
authors.lastname: Bassi
authors.forename: Paola
authors.initials: P
authors.lastname: Imbriani
authors.forename: Enza Maria
authors.initials: EM
authors.lastname: Valente
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Pastore
mesh_terms: D000978:Antiparkinson Agents / Q000009:adverse effects*; D046690:Deep Brain Stimulation / Q000379:methods*; D004421:Dystonia / Q000139:chemically induced*; D006801:Humans; D007980:Levodopa / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000235:genetics / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000502:physiology*
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa