title: Dyspnea as a side effect of subthalamic nucleus deep brain stimulation for Parkinson's disease.
abstract: Bilateral subthalamic nucleus deep brain stimulation for Parkinson's disease improves limb function. Unpublished observations from our clinic noted that some subthalamic nucleus deep brain stimulation patients complain of post-operative dyspnea. Therefore, we designed a prospective, longitudinal study to characterize this in greater depth. We used specific questionnaires to assess dyspnea in patients with electrodes in the subthalamic nucleus (n=13) or ventral intermediate thalamus (n=7). St. George's Hospital Respiratory Questionnaire symptom subscale scores were greater in subthalamic nucleus patients (median=18.60, interquartile range=40.80) than ventral intermediate thalamus patients (median = 0.00, interquartile range=15.38) at greater than 6 months post-operatively (p<0.05). Several of the subthalamic nucleus patients exhibited functional impairments as judged by the St. George's Hospital Respiratory Questionnaire impact subscale, the Medical Research Council Dyspnoea Scale, and the Dyspnoea-12 Questionnaire. There was no correlation between limb function ratings, stimulation parameters, or precise electrode position and dyspnea severity. We have shown, for the first time, that dyspnea can be a side effect of subthalamic nucleus deep brain stimulation, and that this dyspnea may be highly disabling.
authors.affiliation: Nuffield Department of Surgical Sciences and Department of Neurosurgery University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; MD-PhD Program, College of Physicians & Surgeons, Columbia University, 630 West 168th Street, P&S 11-511, New York, NY 10032, USA. Electronic address: jc3304@columbia.edu.
authors.forename: Joshua I
authors.initials: JI
authors.lastname: Chalif
authors.affiliation: Nuffield Department of Surgical Sciences and Department of Neurosurgery University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. Electronic address: Holly.Sitsapesan@orh.nhs.uk.
authors.forename: Holly A
authors.initials: HA
authors.lastname: Sitsapesan
authors.affiliation: Nuffield Department of Clinical Neurosciences and FMRIB Centre University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. Electronic address: kyle.pattinson@ndcn.ox.ac.uk.
authors.forename: Kyle T S
authors.initials: KT
authors.lastname: Pattinson
authors.affiliation: Nuffield Department of Clinical Neurosciences and FMRIB Centre University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. Electronic address: mari.herigstad@ndcn.ox.ac.uk.
authors.forename: Mari
authors.initials: M
authors.lastname: Herigstad
authors.affiliation: Nuffield Department of Surgical Sciences and Department of Neurosurgery University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. Electronic address: tipu.aziz@nds.ox.ac.uk.
authors.forename: Tipu Z
authors.initials: TZ
authors.lastname: Aziz
authors.affiliation: Nuffield Department of Surgical Sciences and Department of Neurosurgery University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. Electronic address: alex.green@nds.ox.ac.uk.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Green
mesh_terms: D000342:Affective Symptoms / Q000209:etiology; D000368:Aged; D058443:Catastrophization / Q000209:etiology; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D004417:Dyspnea / Q000209:etiology*; D005221:Fatigue / Q000209:etiology; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000523:psychology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D018709:Statistics, Nonparametric; D020531:Subthalamic Nucleus / Q000502:physiology*; D011795:Surveys and Questionnaires
keywords: Breathlessness; Deep brain stimulation; Dyspnea; Parkinson's disease; Subthalamic nucleus