title: Successful Management of Hemorrhage-Associated Hemiballism After Subthalamic Nucleus Deep Brain Stimulation with Pallidal Stimulation: a Case Report.
abstract: BACKGROUND
  Deep brain stimulation has been widely used for treating several movement disorders including idiopathic Parkinson disease (IPD). The development of hemiballism after an iatrogenic injury to the subthalamic nucleus (STN) such as postoperative hemorrhage or stroke is rare. Employing pallidal DBS to manage hemiballism arising as a result of STN injury is a unique application of this therapeutic modality, which has only been reported twice in the literature.
  
  
  METHODS
  We present a case of a 54-year-old male with levodopa-responsive IPD who underwent STN electrode placement for deep brain stimulation. The immediate postoperative course was uneventful, but the patient suffered a fall 12 weeks after electrode implantation, leading to electrode displacement and subsequent STN hemorrhage, which led to hemiballism. The hemiballism was then subsequently treated with pallidal DBS after medical management was unsuccessful.
  
  
  CONCLUSIONS
  In our case pallidal DBS was effective in treating hemiballism that arose as a result of traumatic displacement of STN DBS electrodes. Medical management and changes in stimulation parameters failed to produce any significant change in the hemiballism. This report is only the third of its kind in the literature wherein hemiballism arising as a result of STN damage after DBS was successfully treated with pallidal stimulation.
authors.affiliation: Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Aqueel
authors.initials: A
authors.lastname: Pabaney
authors.affiliation: Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA. Electronic address: rali1@hfhs.org.
authors.forename: Rushna
authors.initials: R
authors.lastname: Ali
authors.affiliation: Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Lewitt
authors.affiliation: Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Christos
authors.initials: C
authors.lastname: Sidiropoulos
authors.affiliation: Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Schwalb
mesh_terms: D000978:Antiparkinson Agents; D006259:Craniocerebral Trauma / Q000150:complications; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D004351:Drug Resistance; D020820:Dyskinesias / Q000209:etiology* / Q000628:therapy*; D004567:Electrodes, Implanted; D005917:Globus Pallidus; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods*; D010300:Parkinson Disease / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000628:therapy*; D020531:Subthalamic Nucleus; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents
keywords: Deep brain stimulation; Delayed hemorrhage; Hemiballism: Pallidal stimulation; Subthalamic nucleus