title: Deep brain stimulation in multiple system atrophy mimicking idiopathic Parkinson's disease.
abstract: Deep brain stimulation (DBS) is approved for idiopathic Parkinson's disease (IPD) but has a poor evidence base in Parkinson-plus syndromes such as multiple system atrophy (MSA). We describe the clinical and neuropathological findings in a man who was initially diagnosed with IPD, in whom DBS was unsuccessful, and in whom MSA was unexpectedly diagnosed at a subsequent autopsy. This case report highlights that DBS is often unsuccessful in MSA and also demonstrates that MSA can masquerade as IPD, which may explain treatment failure in a small group of patients apparently suffering from Parkinson's disease. Additionally, it also presents a case with an unusually long duration of disease prior to death, comparable only to a handful of other cases in the literature.
authors.affiliation: Queen Alexandra Hospital, Portsmouth, Oxford, UK.
authors.forename: Navamayooran
authors.initials: N
authors.lastname: Thavanesan
authors.affiliation: Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Gillies
authors.affiliation: Department of Neuropathology, Beaumont Hospital, Dublin, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Farrell
authors.affiliation: Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK.
authors.forename: Alex L
authors.initials: AL
authors.lastname: Green
authors.affiliation: Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK.
authors.forename: Tipu
authors.initials: T
authors.lastname: Aziz
keywords: Deep brain stimulation; Idiopathic Parkinson's disease; Multiple system atrophy